The Office of the Inspector General to Audit Practices - Including Chiropractic
Ottsville, PA – The Office of the Inspector General Announced its work plan for 2009. Among the many important issues in this 115 page document is a plan to audit Chiropractic Offices. Electronic Medical Records systems, such as the Paperless Office offers a system to correctly document medical necessity. An excerpt from the plan follows:Medicare Payments for Chiropractic Services Billed With the Acute Treatment Modifier
We will review chiropractor billings with acute treatment (AT) modifiers to determine whether they comply with Medicare coverage criteria and documentation requirements. The Social Security Act, § 1861(r)(5), defines physicians as including chiropractors, but only for treatment by manual manipulation of the spine to correct subluxations of the spine. Chiropractors must use an AT modifier to identify services that are active or corrective treatment of an acute or chronic subluxation. Federal regulations at 42 CFR § 410.21(b) further limit Medicare payment to treatment of subluxations that result in a neuromusculoskeletal condition for which manual manipulation is appropriate treatment. The Social Security Act, §§ 1862(a)(1)(A) and 1833(e), provides that Medicare pay for services only if they are medically necessary and supported by documentation. A prior OIG review of services allowed in 2001 found that 40 percent of chiropractic services were for maintenance therapy and thus did not meet Medicare coverage criteria, potentially costing the program and its beneficiaries approximately $186 million in improper payments. We will determine the appropriateness of Medicare payments for chiropractic claims identified as maintenance therapy.
(OEI; 07-07-00390; expected issue date: FY 2009; work in progress)
The The entire plan for 2009 can be found here. Electronic Medical Records solutions available to DBC customers can be found here.
A FREE trial is available for download.
website: www.dbconsultants.com.
