Medicare

Medicare Documentation Requirements: The Hurdle That Continues to Block Our Progress

By Frank M. Painter|May 2, 2012|Documentation, Medicare|

Medicare Documentation Requirements:
The Hurdle That Continues to Block Our Progress

SOURCE: Dynamic Chiropractic ~ April 9, 2012

By David Seaman, DC, MS, DABCN,
Albert J. Luce, DC and
Anthony Hamm, DC, FACO, DABFP

At present, the chiropractic profession has difficulty being compliant with Medicare documentation requirements. The 2009 report from the Office of the Inspector General reported the following: “Distinct from the undocumented claims, 83 percent of reviewed chiropractic claims failed to meet one or more of the documentation requirements.

Concerning treatment, file reviewers reported that only 76 percent contained some form of treatment plan, 43 percent lacked treatment goals, 17 percent lacked objective measures, and 15 percent lacked the recommended level of care.” [1]

In January 2011, the California Chiropractic Association reported the following on its Web site: [2] “Palmetto GBA has released the results of its review of chiropractic Medicare claims and found an “unacceptable” error rate of 68 percent for Northern California and 77 percent for Southern California. These results are very troubling, as Congressional leaders have threatened to remove chiropractic from Medicare if the profession [does] not improve its billing practices.”

Perhaps two primary issues may be at work. Either an inaccurate message is being delivered to chiropractors regarding appropriate Medicare documentation requirements and/or chiropractors are misinterpreting the message. Let’s attempt to clear up some of the confusion, outline documentation requirements based on several Medicare publications, and provide a flow chart for easy visualization of the required process.

Refer to MEDICARE DOCUMENTATION SIMPLIFIED Chart

What Does Medicare Want? (more…)

Utilization, Cost, and Effects of Chiropractic Care on Medicare Program Costs

By Frank M. Painter|August 22, 2011|Medicare|

Utilization, Cost, and Effects of Chiropractic Care on Medicare Program Costs

The Chiro.Org Blog

An older study of Medicare cost data completed in June (2001 or 2002) by the well-known Washington, DC-based firm Muse & Associates helps demonstrate the cost-saving impact that chiropractic care has on the current Federal Medicare program.

The study, titled “Utilization, Costs, and Effects of Chiropractic Care on Medicare Program Costs“, was commissioned by the ACA and is the first study of its type to compare the global, per capita Medicare expenditures of chiropractic patients to those of non-chiropractic patients receiving care in the federal Medicare program. The study utilizes data obtained from Medicare’s Standard Analytical Files for 1999 — the most recent year that cost data was available for analysis.

The study’s executive summary states:

“The results strongly suggest that chiropractic care significantly reduces per beneficiary costs to the Medicare program. The results also suggest that Chiropractic services could play a role in reducing costs of Medicare reform and/or a new prescription drug benefit.”

The study specifically found that:

Beneficiaries who received chiropractic care had lower average Medicare payments for all Medicare services than those who did not ($4,426 vs. $8,103);

Beneficiaries who received chiropractic care averaged fewer Medicare claims per capita than those who did not; and

Beneficiaries who received chiropractic care had lower average Medicare payments per claim than those who did not.

(more…)

Postponement of Medicare Pay Cut Is Stripped From The Jobs Bill

By Frank M. Painter|February 19, 2010|Medicare, News|

Postponement of Medicare Pay Cut Is Stripped From The Jobs Bill

The Chiro.Org Blog

A Chiro.Org Editorial

Physicians continue to hope for a reprieve from the proposed 21.2% Medicare pay cut scheduled to begin on March 1, as another legislative solution to the reimbursement crisis fizzled this week in a hyperpolarized Congress.

A jobs-creation bill, crafted by Senate Democrats and Republicans earlier this week, originally would have delayed the massive cut to October 1, but this provision and many others were stripped out within days as Senate Majority Leader Harry Reid (D-NV) shrank the bill’s cost from $85 billion to an estimated $15 billion.

Now Congress has only 2 weeks to pass legislation that would avert the 21.2% reduction in Medicare reimbursement. Organized medicine warns that if the cuts go through, physicians will turn away new Medicare patients or even drop out of the system instead of going broke on paltry fees. The average physician depends on Medicare for 31% of his or her revenue, according to the Center for Studying Health System Change (HSC).

As in the past, this does not mean that every service will be reduced. In fact, the E&M codes (99201-05 and 99211-15) which medical physicians use to code virtually every visit, has continued to climb in reimbursement by 3-5% yearly, while Chiropractic Spinal Manipulation (SMT) has continued to decline, year after year. (more…)