Medicare or Medi-Scare?
This excerpt was sent to me today in an email. It originated from Dr. Leonard from the Wisconsin Chiropractic Association.
Subject: Will Medicare Fire Chiropractic Based on OIG Finding?
Will Medicare Fire Chiropractic?
Attached is a copy of a report issued by the Office of Inspector General (OIG) on payments made to chiropractors for Medicare services. The audit’s findings were as follows:
Medicare inappropriately paid $178 million for chiropractic claims in 2006, representing 47 percent of claims meeting our study criteria.
Efforts to stop payments for maintenance therapy have been largely ineffective.
Claims data lack initial visit dates for treatment episodes, hindering the identification of maintenance therapy.
Chiropractors often do not comply with the Manual documentation requirements.
88% of the reviewed claims had inappropriate payments for “maintenance therapy”, 26% for undocumented care, and 6% for miscoded care. 20% of the claims had multiple errors. Separate from the undocumented claims counted as errors, 83 % of chiropractic claims failed to meet one or more of the documentation requirements.
In the past, when reports regarding the chiropractic profession have been required by Congress, the reports were inexcusably delayed. This report seems to have been issued at a time calculated to do maximum damage to the chiropractic profession – in the middle of the debate over health care reform.
If the chiropractic profession does not immediately and aggressively respond to the conclusions of this report, every one of our competitors will point to this report as an excuse to disregard the chiropractic profession as decisions are made on the benefits to be included or the reforms that are to be made in the health care reform bill.
We believe the report has a critical flaw in that its definition of “maintenance therapy” is discriminatory and it is nearly impossible to apply to a particular case via a review of chiropractic documentation.
The Medicare policy manual defines “maintenance therapy” as follows:
Maintenance therapy is defined as a treatment plan that seeks to prevent disease, promote health, and prolong and enhance the quality of life; or therapy that is performed to maintain or prevent deterioration of a chronic condition. When further clinical improvement cannot reasonably be expected from continuous ongoing care, and the chiropractic treatment becomes supportive rather than corrective in nature, the treatment is then considered maintenance therapy. For information on how to indicate on a claim a treatment is or is not maintenance, see §240.1.3.
Discrimination
First, it is critical to note that Medicare has a different standard for chiropractors than it does for medical providers. Medicare routinely pays for the medical treatment of symptomatic chronic conditions including heart disease, rheumatoid arthritis, diabetes, macular degeneration, allergies, and many others. On the other hand, Medicare states that chiropractic adjustments “performed to maintain or prevent deterioration of a chronic condition” are maintenance therapy. For Medicare patients, medical treatment that keeps a chronic or degenerative condition from worsening is accepted; but it is a violation of the law for chiropractors to provide the same standard of care to their patients.
Definition of maintenance care
When a Medicare patient presents with another episode of a chronic condition, their chiropractor cannot know whether it is a new problem or an exacerbation of a previous problem until he/she examines the patient (which Medicare will not pay for). At this point, if the chiropractor determines the pain is due to an exacerbation of a previous problem, they are supposed to guess, based on the current deterioration of the patient’s spine, whether or not this treatment plan will fully resolve the problem because if it merely prevents deterioration of the condition to the point where, for instance, it might require expensive surgery, a chiropractor violates the law by providing care.
The chiropractic profession has never challenged this absurd definition of maintenance therapy. It appears to have been written by an individual without specialized knowledge of the needs of the elderly with regard to their spinal problems. The overwhelming percentage of Medicare patients who seek care from chiropractors are suffering from chronic conditions. If a chiropractor is able to document that acute symptomtology is present, these patients should not be viewed by Medicare to be receiving maintenance therapy.
Other problems
The OIG report also found that 26% of the audited claims had inappropriate payments for undocumented care. Clearly there should be no payment for chiropractic services when a chiropractor fails to document their clinical interaction with the patient. However, the basis for these determinations was opinions of reviewers hired by OIG.
OIG stated they “worked with the medical review contractor to select chiropractors with previous experience in reviewing chiropractic services provided to Medicare beneficiaries to serve as medical reviewers for this study”. The chiropractic profession is all too familiar with the bias of chiropractic reviewers who skew their opinion to retain their employment relationship. Without an unbiased review of the credentials of those performing this “review” work, the chiropractic profession should insist that an unbiased third party with impeccable credentials confirm the accuracy of these “reviews”.
Because time is of the essence, the response of the profession to this report needs to be widely disseminated to members of Congress and the Obama administration before our competitors seek to destroy our credibility in the negotiations over national health care reform.
Regards,
Russ Leonard
Executive Director
Wisconsin Chiropractic Assn
(608) 256-7023 Ph
(608) 256-7123 Fax
Subject: Will Medicare Fire Chiropractic Based on OIG Finding?
Will Medicare Fire Chiropractic?
Attached is a copy of a report issued by the Office of Inspector General (OIG) on payments made to chiropractors for Medicare services. The audit’s findings were as follows:
Medicare inappropriately paid $178 million for chiropractic claims in 2006, representing 47 percent of claims meeting our study criteria.
Efforts to stop payments for maintenance therapy have been largely ineffective.
Claims data lack initial visit dates for treatment episodes, hindering the identification of maintenance therapy.
Chiropractors often do not comply with the Manual documentation requirements.
88% of the reviewed claims had inappropriate payments for “maintenance therapy”, 26% for undocumented care, and 6% for miscoded care. 20% of the claims had multiple errors. Separate from the undocumented claims counted as errors, 83 % of chiropractic claims failed to meet one or more of the documentation requirements.
In the past, when reports regarding the chiropractic profession have been required by Congress, the reports were inexcusably delayed. This report seems to have been issued at a time calculated to do maximum damage to the chiropractic profession – in the middle of the debate over health care reform.
If the chiropractic profession does not immediately and aggressively respond to the conclusions of this report, every one of our competitors will point to this report as an excuse to disregard the chiropractic profession as decisions are made on the benefits to be included or the reforms that are to be made in the health care reform bill.
We believe the report has a critical flaw in that its definition of “maintenance therapy” is discriminatory and it is nearly impossible to apply to a particular case via a review of chiropractic documentation.
The Medicare policy manual defines “maintenance therapy” as follows:
Maintenance therapy is defined as a treatment plan that seeks to prevent disease, promote health, and prolong and enhance the quality of life; or therapy that is performed to maintain or prevent deterioration of a chronic condition. When further clinical improvement cannot reasonably be expected from continuous ongoing care, and the chiropractic treatment becomes supportive rather than corrective in nature, the treatment is then considered maintenance therapy. For information on how to indicate on a claim a treatment is or is not maintenance, see §240.1.3.
Discrimination
First, it is critical to note that Medicare has a different standard for chiropractors than it does for medical providers. Medicare routinely pays for the medical treatment of symptomatic chronic conditions including heart disease, rheumatoid arthritis, diabetes, macular degeneration, allergies, and many others. On the other hand, Medicare states that chiropractic adjustments “performed to maintain or prevent deterioration of a chronic condition” are maintenance therapy. For Medicare patients, medical treatment that keeps a chronic or degenerative condition from worsening is accepted; but it is a violation of the law for chiropractors to provide the same standard of care to their patients.
Definition of maintenance care
When a Medicare patient presents with another episode of a chronic condition, their chiropractor cannot know whether it is a new problem or an exacerbation of a previous problem until he/she examines the patient (which Medicare will not pay for). At this point, if the chiropractor determines the pain is due to an exacerbation of a previous problem, they are supposed to guess, based on the current deterioration of the patient’s spine, whether or not this treatment plan will fully resolve the problem because if it merely prevents deterioration of the condition to the point where, for instance, it might require expensive surgery, a chiropractor violates the law by providing care.
The chiropractic profession has never challenged this absurd definition of maintenance therapy. It appears to have been written by an individual without specialized knowledge of the needs of the elderly with regard to their spinal problems. The overwhelming percentage of Medicare patients who seek care from chiropractors are suffering from chronic conditions. If a chiropractor is able to document that acute symptomtology is present, these patients should not be viewed by Medicare to be receiving maintenance therapy.
Other problems
The OIG report also found that 26% of the audited claims had inappropriate payments for undocumented care. Clearly there should be no payment for chiropractic services when a chiropractor fails to document their clinical interaction with the patient. However, the basis for these determinations was opinions of reviewers hired by OIG.
OIG stated they “worked with the medical review contractor to select chiropractors with previous experience in reviewing chiropractic services provided to Medicare beneficiaries to serve as medical reviewers for this study”. The chiropractic profession is all too familiar with the bias of chiropractic reviewers who skew their opinion to retain their employment relationship. Without an unbiased review of the credentials of those performing this “review” work, the chiropractic profession should insist that an unbiased third party with impeccable credentials confirm the accuracy of these “reviews”.
Because time is of the essence, the response of the profession to this report needs to be widely disseminated to members of Congress and the Obama administration before our competitors seek to destroy our credibility in the negotiations over national health care reform.
Regards,
Russ Leonard
Executive Director
Wisconsin Chiropractic Assn
(608) 256-7023 Ph
(608) 256-7123 Fax
Labels: Medicare, or is it Medi-scare?
posted by Dr. Scott J. Heun at
1:04 PM
