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OIG's Recent Report on Chiropractic Services

Many chiropractors in Florida have received a copy of a recent report from the Office of Inspector General, U.S. Department of Health and Human Services that calls for better controls to prevent fraud, waste and abuse related to chiropractic services in Medicare.  This report is based on services between 2010 and 2014 and provides us two important lessons. 

First Coast Service Options (FCSO) Repayment Letters On Medicare Audit Findings

The FCA has received confirmation from some members that they have received letters from FCSO requesting repayments on audited claims denied by Strategic Health Solutions (SHS). There has also been at least one notice of additional payments received on codes reported as under coded. There are no reports of the repayments including an extrapolation to all payments made in 2015.
 
This is VERY good news.
 
The positive is that there was no extrapolation.  Most chiropractic physicians affected will be dealing with a couple thousand of dollars at most instead of tens or hundreds of thousands of dollars.

So what should those doctors who were audited do now?
 

Changes Coming on Which Diagnoses to Bill for Florida Medicare

First Coast Service Options, the Florida Medicare Contractor, will be updating their LCD for Chiropractic Services in the near future.

Hardship Exemptions Possible

If you will not be attesting to or meeting Meaningful Use through the implementation of a certified Electronic Health Record during 2015, you may be eligible for a "Hardship Exemption" that would avoid that reimbursement reduction in 2017. The deadline for applying for this exemption has been moved to July 1,2016.

Holding of 2016 claims and other Medicare 2016 resources

Reminder: On October 30, 2015, the calendar year (CY) 2016 Medicare physician fee schedule (MPFS) final rule was published in the Federal Register. In order to implement corrections to technical errors discovered after publication of the MPFS rule and process claims correctly, Medicare administrative contractors will hold claims containing 2016 services paid under the MPFS for up to 14 calendar days (i.e., Friday January 1, 2016, through Thursday January 14, 2016). Per CMS, the hold should have minimal impact on provider cash flow as, under current law, clean electronic claims are not paid sooner than 14 calendar days (29 days for paper claims) after the date of receipt.

PQRS 2016 Reporting Measures for Chiropractic Physicians Available

The ACA has posted the 2016 PQRS measures for Chiropractic Physicians.  The codes and additional information are available through this link.

CMS has distributed a listserv announcing the extension of the PY 2014 PQRS Informal Review process

CMS has distributed a listserv announcing the extension of the PY 2014 PQRS Informal Review process to December 11, 2015. This impacts individuals and group practices that are subject to the 2016 PQRS negative payment adjustment based on PQRS reporting in 2014.

FCSO Is Promoting Electronic Remittance Advices

First Coast Service Options, the Florida Medicare Contractor for Regular/Original Medicare claims, is encouraging providers that are currently receiving paper Remittance Advices (EOB's) to sign up for Electronic Remittance Advices. We are assured that this remains voluntary, but offers the benefits of electronic technology. Read further to learn more and view the notice from First Coast.

Senate Clears Legislation to Prevent Medicare Payment Cuts

Chiropractic documentation education, new quality-reporting incentives included in measure
 
Arlington, Va. - The U.S. Senate, following the earlier lead of the House, late last night passed a long-awaited "permanent fix" to the flawed Sustainable Growth Rate (SGR) formula used to determine provider reimbursement levels under the federal Medicare program. The plan would give physicians treating Medicare patients, including doctors of chiropractic (DCs), an annual payment increase of 0.5 percent for the next five years, with value-based payments starting after that time.

Meaningful Use Deadline Pushed Back One Year

(From ACA Week in Review of December 19, 2013)  On Friday, Dec. 6, the Centers for Medicare and Medicaid Services (CMS) announced a one-year extension of the deadline for doctors and hospitals to meet standards for use of electronic health records (EHRs). Health care providers will have until the end of 2016 to meet stage two criteria for making meaningful use of electronic records. This pushes the stage three start date for the earliest adopters of EHRs back one year to 2017.

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