Medicare: Penny Wise and Pound Foolish
Published: 2009-08-18 22:49:47
Author: Christopher Kent | Dynamic Chiropractic | August 12, 2009
By now, most of you have heard about the scathing 2009 report on chiropractic from the Office of the Inspector General (OIG). This is the latest in a series critical of chiropractic claims.
OIG reports from 1986, 1998, 1999 and 2005 also allege that inappropriate payments were made for maintenance therapy and miscoded, improperly documented claims. The response from the chiropractic profession has been a sort of collective mea culpa. Professional organizations have vowed to address documentation problems, while entrepreneurs have offered seminars, publications and software programs promising to make your practice "audit proof."
The timing of the report's release, given the debate on national health policy, would appear to play into the hands of those who would like to "contain and eliminate" the chiropractic profession. To put things in perspective, total Medicare expenditures for 2006, the year reviewed in the latest report, amounted to more than $382 billion. The report notes that expenditures for chiropractic services in 2006 amounted to $466 million. This is 0.12 percent of the total Medicare expenditures. The amount of alleged overpayment was $178 million, or 0.047 percent of the total.
The methodological shortcomings of the report, including unsubstantiated claims, faulty logic and outright bias, are beyond the scope of this article. Interested readers are referred to a comprehensive analysis of the OIG report by Matthew McCoy, DC, MPH, which is available online at no cost. An overriding concern is that the OIG report demonstrates a fundamental lack of understanding of vertebral subluxation. Furthermore, it reflects a perspective that should be at the heart of any health care reform debate.
The Centers for Medicare & Medicaid Services (CMS) limits care of vertebral subluxations not associated with a secondary condition by defining them as "maintenance therapy," which is not a covered condition. CMS defines maintenance therapy as follows: "A care plan that seeks to prevent disease, promote health and prolong and enhance the quality of life, or maintain or prevent deterioration of a chronic condition." While this should be the goal of every doctor, regardless of specialty, Medicare explicitly excludes such services.
Full story
Published: 2009-08-18 22:49:47
Author: Christopher Kent | Dynamic Chiropractic | August 12, 2009
By now, most of you have heard about the scathing 2009 report on chiropractic from the Office of the Inspector General (OIG). This is the latest in a series critical of chiropractic claims.
OIG reports from 1986, 1998, 1999 and 2005 also allege that inappropriate payments were made for maintenance therapy and miscoded, improperly documented claims. The response from the chiropractic profession has been a sort of collective mea culpa. Professional organizations have vowed to address documentation problems, while entrepreneurs have offered seminars, publications and software programs promising to make your practice "audit proof."
The timing of the report's release, given the debate on national health policy, would appear to play into the hands of those who would like to "contain and eliminate" the chiropractic profession. To put things in perspective, total Medicare expenditures for 2006, the year reviewed in the latest report, amounted to more than $382 billion. The report notes that expenditures for chiropractic services in 2006 amounted to $466 million. This is 0.12 percent of the total Medicare expenditures. The amount of alleged overpayment was $178 million, or 0.047 percent of the total.
The methodological shortcomings of the report, including unsubstantiated claims, faulty logic and outright bias, are beyond the scope of this article. Interested readers are referred to a comprehensive analysis of the OIG report by Matthew McCoy, DC, MPH, which is available online at no cost. An overriding concern is that the OIG report demonstrates a fundamental lack of understanding of vertebral subluxation. Furthermore, it reflects a perspective that should be at the heart of any health care reform debate.
The Centers for Medicare & Medicaid Services (CMS) limits care of vertebral subluxations not associated with a secondary condition by defining them as "maintenance therapy," which is not a covered condition. CMS defines maintenance therapy as follows: "A care plan that seeks to prevent disease, promote health and prolong and enhance the quality of life, or maintain or prevent deterioration of a chronic condition." While this should be the goal of every doctor, regardless of specialty, Medicare explicitly excludes such services.
Full story