The U.S. Department of Health and Human Services (HHS) Office of the Inspector General (OIG) recently analyzed Medicare paid claims for chiropractic services from 2013.

A major finding: In 2013, $76 million in Medicare payments for chiropractic services were questionable, with Medicare inappropriately paying $21 million for chiropractic services that lacked a primary diagnosis covered by Medicare, according to an OIG report.

The OIG’s notes that chiropractic services have the highest rate of improper payments among Part B services, according to the Centers for Medicare & Medicaid Services’ (CMS) Comprehensive Error Rate Testing program. Medicare covers chiropractic services to improve function (“active treatment”), but it does not cover “maintenance therapy,” which is when further clinical improvement cannot be reasonably expected from ongoing treatment.

While the millions of dollars tied to Medicare documentation deficiencies is significant, what may be just as significant is the fact that almost half of the questionable payments were for claims suggestive of maintenance therapy, and just 2% of chiropractors were responsible for half of the questionable payments.  

According to American Chiropractic Association President Anthony Hamm, DC, in a news release, “Proper documentation is integral to our work moving forward to further integrate the essential services provided by chiropractic physicians in Medicare. Poor documentation is not only a black eye on the profession; more importantly, it reflects poorly on the deliverance of quality-driven care for our patients.” 

To reduce questionable payments, OIG made the following recommendations for CMS:

  1. establish a more reliable control for identifying active treatment, which would enable CMS to identify potential maintenance therapy;
  2. develop and use measures to identify questionable payments for chiropractic services;
  3. take appropriate action on the chiropractors with questionable payments;
  4. collect overpayments based on inappropriately paid claims; and
  5. ensure that claims are paid only for Medicare-covered diagnoses.

OIG noted that CMS did not concur with the first recommendation, but concurred with the other recommendations.

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