Medical Billing and Coding Healthcare Blog

More than 54% of all Medicare payments made to chiropractors in 2014 were incorrect, according to a recent Medicare report (pdf).

Chiropractic services had the highest rate of improper payments out of 20 services documented, which will likely lead to increased scrutiny and audits from Medicare, and may even encourage commercial payers to more closely review claims filed by chiropractors.

According to the Department of Health and Human Services data in the "Medicare Fee-for-Service 2014 Improper Payments Report," the 54.1% error rate — determined through the analysis of a 718 claims sample — resulted in more than $303 million in improper payments.

The primary type of error leading to improper payment was insufficient data, accounting for a little more than 92% of the errors. Medical necessity was the second leading cause, at a little less than 5%, with no documentation as the third highest error at just over 2%.

In a closer examination of chiropractic manipulation (98941) claims, Medicare data indicated an overpayment rate of 52.7%, with almost 49% of claims containing errors.

Rounding out the top five services with the highest rate of improper payment were lab tests (36.1%), initial hospital visits (31.3%), critical care hospital visits (29.2%) and psychiatry services (29.2%).

If you are struggling to submit proper chiropractic claims and are unconcerned about whether your practice is receiving appropriate payment for services provided, consider outsourcing your billing to PGM Billing, one of the nation's leading chiropractic billing companies. PGM has more than 30 of experience in providing chiropractic billing services. Contact us today to learn what our team of certified medical billing and coding experts can do for you.

The Centers for Medicare & Medicaid Services (CMS) has announced that coinsurance and deductible are not being waived on claims containing codes G0473 (intensive behavioral therapy for obesity) and 77063 (screening digital breast tomosynthesis, bilateral).

CMS notes the problem, a result of a systems error, will be corrected on April 6, 2015.

For claims with dates of service of January 1, 2015, through March 31, 2015, Medicare administrative contractors will be mass adjusting these claims and issuing corrected payments for all impacted claims.

CMS states providers must reimburse beneficiaries for any overpayment caused by this error.

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