BREAKING NEWS FROM THE ACA From Dick Clark DC Ga. ACA Delegate This report puzzles me because in 2001 it was very difficult to get the Medicare coverage that was needed to treat a patient properly. I had a large number of complaints from DCs that were not allowed or denied visits that were desperately needed by the patient. Most of my personal denials came after the patients first visit when the Medicare refusal stated that the patient has had too many visits for this condition or this period of time.(That was after one visit) As you will note in reading this article the ACA and our legal staff are on top of this article and will pursue it until a sensible conclusion is reached. > Hello, everyone. > > Yesterday, the Office of Inspector General released a report titled > "Chiropractic Services in the Medicare Program: Payment Vulnerability > Analysis." The OIG found that approximately 67 percent of the > chiropractic > services allowed by Medicare in 2001 did not meet Medicare coverage > criteria > and/or were miscoded, or were undocumented, potentially costing the > program > and its beneficiaries approximately $285 million. A copy of the report > can > be found on the OIG Web site here: > http://www.oig.hhs.gov/oei/reports/oei-09-02-00530.pdf > > Obviously, ACA takes issue with the report, and we've put together a > preliminary statement on the report, which can be found directly below. We > will be > analyzing the report further and then distributing a more in- depth > analysis > as soon as possible. > > We've already received a call from the Associated Press (resulting story > at > very bottom of email below ACA's statement) on this report and anticipate > more inquiries in the days to come. We will keep you posted as to any > further developments. > > * * * * * > > Angela Kargus > Communications & PR Manager > American Chiropractic Association > 1701 Clarendon Blvd. > Arlington, VA 22209 > P: (703) 276-8800 > F: (703) 243-2593 > akargus@amerchiro.org > www.acatoday.com > > > Inspector General Medicare Report Based on Outdated Information, > Misrepresents ACA's Position on Frequency Limits > > The ACA is currently reviewing the report released June 21, 2005, by the > Office of the Inspector General. It is important to note that data > reviewed > in this report were taken from 2001. Since that time, the ACA has taken > steps to reduce chiropractic error rates, including the release of a > comprehensive documentation manual and increased education of its members. > In addition, as of October 2004 doctors of chiropractic together with the > Centers for Medicare and Medicaid Services (CMS) implemented the use of > the > Active Treatment (AT) modifier to reflect claims for active/corrective > treatment. The ACA believes that these proactive measures will positively > impact the results of future error reviews. > > Furthermore, contrary to what is suggested within the report, at no time > has > the ACA ever expressed support for a national frequency cap on > chiropractic > services. In fact, the ACA fought diligently to block the CMS proposal > that > would have allowed insurance carriers to begin to impose arbitrary caps on > chiropractic services received by Medicare beneficiaries. Copies of > correspondence between ACA and the Health Care Financing Administration > (now > known as CMS) regarding frequency caps can be found at www.acatoday.com. > > A more detailed analysis of the OIG report will be posted on the ACA's Web > site as soon as it is available. > > > Taxpayers Overbilled for Chiropractic Work > > By KEVIN FREKING > The Associated Press > Tuesday, June 21, 2005; 5:35 PM > > > WASHINGTON -- In one year, the government paid chiropractors for nearly > $285 > million in services that should not have been billed to Medicare, an > inspector general's report said Tuesday. > > Since 2001, the year studied, the demand for chiropractic services has > increased. To prevent abuses, caps should be placed on the number of times > that Medicare could be billed for chiropractic services for a patient, > Health and Human Services' inspector general said. > > "The need for a more effective way to eliminate inappropriate maintenance > payments is crucial," the report said. > > The questionable payments in 2001 amount to $2 out of every $3 that > Medicare > spent on chiropractic services that year. The payments were improper > because > they reimbursed providers for treatments that failed to meet the > government's criteria for medical necessity, or because providers lacked > the > proper documentation to prove the services were needed, the report said. > > The American Chiropractic Association, noting that the data cited by the > IG's office is four years old, said the government instituted new > procedures > last year designed to help chiropractors avoid improperly billing the > government. Medicare will reimburse for manipulation of the spine that is > designed to improve a chronic or acute condition, but it is not supposed > to > reimburse chiropractors for simply maintaining a health condition. > > The vast majority of improper payments, or $251 million, was for > maintenance, the IG said. > > "The procedures were put in place not quite a year ago, and it's intended > to > address the very problem they're talking about in this report," said > Thomas > Daly, a lawyer with the association, which represents about 12,000 > chiropractors. "They wouldn't have the statistics to report whether it's > having an impact or not. That's why we're a little mystified why they > didn't > go into what's happening now." > > Daly said the association disagreed with the IG's recommendation that the > government cap the number of times that it will pay for chiropractic > services. > > "We think an appropriate test is whether those services are reasonable and > necessary," Daly said. > > The inspector general's office said taxpayers could realize significant > savings from the caps. > > "When chiropractic care extends beyond 12 treatments in a year, it becomes > increasingly likely that individual services are medically unnecessary," > the > report said. > > ___ > > On the Net: > > IG's office: http://www.oig.hhs.gov > > American Chiropractic Association: > http://www.amerchiro.orghttp://www.acatoday.com > ______________________________________________________ > > ______________________________________________________ ________________ > This email has been scanned by the MessageLabs Email Security System. > > > ----------------------- Headers -------------------------------- Return-Path: Received: from rly-yj05.mx.aol.com (rly-yj05.mail.aol.com [172.18.180.143]) by air-yj02.mail.aol.com (v106.2) with ESMTP id MAILINYJ23-81742b98924181; Wed, 22 Jun 2005 11:52:20 -0400 Received: from imf18aec.mail.bellsouth.net (imf18aec.mail.bellsouth.net [205.152.59.66]) by rly-yj05.mx.aol.com (v106.2) with ESMTP id MAILRELAYINYJ53-81742b98924181; Wed, 22 Jun 2005 11:52:05 -0400 Received: from ibm61aec.bellsouth.net ([68.213.37.194]) by imf18aec.mail.bellsouth.net with ESMTP id <20050622155203.WJLL2372.imf18aec.mail.bellsouth.net@ibm61aec.bellso uth.net>; Wed, 22 Jun 2005 11:52:03 -0400 Received: from D3Z4M571 ([68.213.37.194]) by ibm61aec.bellsouth.net with SMTP id <20050622155202.CGBY4468.ibm61aec.bellsouth.net@D3Z4M571>; Wed, 22 Jun 2005 11:52:02 -0400 Message-ID: <00b101c5003e$112fe110$6400a8c0@D3Z4M571> From: "Dick Clark DC" To: Subject: Fw: OIG Report on Chiropractic in Medicare Date: Fri, 21 Jan 2005 22:51:36 -0600 MIME-Version: 1.0 Content-Type: text/plain; format=flowed; charset="iso-8859-1"; reply-type=original Content-Transfer-Encoding: 7bit X-Priority: 3 X-MSMail-Priority: Normal X-Mailer: Microsoft Outlook Express 6.00.2900.2180 X-MimeOLE: Produced By Microsoft MimeOLE V6.00.2900.2180 X-AOL-IP: 205.152.59.66 X-AOL-SCOLL-SCORE: 0:2:438818526:11327976 X-AOL-SCOLL-URL_COUNT: 0