For those of you who have heard the news about the newly updated 2009 Medicare OIG Report, you probably heard that chiropractors still did not fare very well.  The now infamous 2005 OIG Report blasted chiropractors for a significantly high claims error rate and, unfortunately, the 2009 OIG Report is not very flattering either.

However, as the full text of the report emerged and details were examined, many in the chiropractic profession were quick to note that the 2009 Report contained some serious flaws and possible misleading conclusions.   (For e-newsletter subscribers, see my 5-19-09 issue)

Fortunately, there has been an official ACA Reponse to the OIG report which critiques some of the obvious shortcomings of the OIG report that put chiropractors in a bad light.

It appears to be a great waste that the OIG would take the time, money and effort to follow-up on their 2005 report and create such a methodologically flawed document with questionable conclusions.

In addition to the criticisms launched by the ACA in their response (which I encourage you to read by clicking the link above), here are a few examples of the shortcomings that I found as well:

1. Sample size: IF chiropractic claims represent such a large segment of error-filled submissions that are somehow clogging up the Medicare system, wouldn’t it be prudent to obtain a statistically significant sample size to assess the problem accurately?  Instead, with $466 million worth of chiropractic claims in the system, the new OIG report looked at a mere 188 claims to come to its conclusions.  Since DC’s have one of the lowest $ per claim value in Medicare (since we can only bill for adjustments), these 188 claims probably represent about as statistically INSIGNIFICANT a number as possible!
2. No Credit for Improvements Made:  Though the new OIG report was quick to point out chiropractic’s poor track record and that chiropractors routinely don’t comply with Medicare requirements, it failed to acknowledge that there was a distinct IMPROVEMENT in % of errors in chiropractic claims from the 2005 report to present.
3. Skewed Data Pool.  Instead of pulling a random selection of claims (and a larger one at that), the new report specifically weeded out all claims for episodes under 12 visits.  Although the report does not indicate how many chiropractors routinely treat with this visit frequency, this is certainly not an accurate sampling of chiropractic treatment patterns and represents a statistically skewed sample group.

All in all, there are still things to learn from this document – however flawed.

As chiropractors, we still need to take initiative to make sure our billing, coding & documentation are compliant with Medicare or other third party payer regulations.

If we can draw conclusions from this report, it is obvious that we need to be even more vigilant with medical necessity and documentation issues as treatment progresses.

Finally, one item the report did find was several claims with no documentation.  Who knows has this happened, but as a profession we must establish zero tolerance for this type of violation of basic record keeping.

Related posts:

1. Answers to Common Chiropractic Medicare Problems In my last article on The Perennial Problem of Medicare...
2. The Medicare Mess Continues to Affect Chiropractic In case you were really hankering for some bad news...
3. The Perennial Problem of Medicare for Chiropractors Here are some answers to the questions that many of...