Medicare Improper Payment Report for Chiropractic (2016)

September 1st, 2017 - Wyn Staheli
Categories:   Office of Inspector General (OIG)   Chiropractic   Claims  

The Medicare Improper Payment Report for 2016 has been released by the OIG. Please note that the improper payment rate does not measure fraud. Rather, it estimates the payments that did not meet Medicare coverage, coding, and billing rules. The estimated Medicare FFS payment accuracy rate (claims paid correctly) from July 1, 2014 through June 30, 2015, was 89.0 percent. The estimated improper payment rate (claims paid incorrectly) was 11.0 percent which is a decrease from last years 12.1 percent rate.

As with most years, the biggest problem was the lack of documentation to support the services or supplies billed (64 percent of improper payments). It should be noted that although those numbers have decreased from last year, there is still room for improvement. Although not the worst offender, chiropractic claims still score poorly on insufficient documentation as indicated in the table below.

Chiropractic Claims Error Report

Part B Services

Improper Payment Rate

Type of Error

No Doc

Insufficient Doc

Medical Necessity

Incorrect Coding

Other

Chiropractic

46.0%

2.2%

92.1%

3.6%

1.6%

0.5%

The following table (Table A2) from this report summarizes the problems by various categories and claim types for all providers. It is helpful to see how chiropractic claims stack up compared to the national averages.

Table A2: Comparison of 2015 and 2016 National Improper Payment Rates by Error Category (Adjusted for Impact of A/B Rebilling)

 

2015

2016

       
Error Category

Total

Total

Part A Excluding Hospital IPPS

Part A Hospital IPPS

Part B

DMEPOS

No Documentation

0.2%

0.1%

0.0%

0.0%

0.1%

0.0%

Insufficient Documentation

8.1%

7.2%

4.2%

0.1%

2.0%

0.8%

Medical Necessity

2.1%

2.2%

1.4%

0.7%

0.1%

0.0%

Incorrect Coding

1.3%

1.1%

0.1%

0.3%

0.7%

0.0%

Other

0.4%

0.4%

0.1%

0.1%

0.0%

0.2%

TOTAL

12.1%

11.0%

5.9%

1.2%

2.9%

1.0%

 

To see more about how chiropractic claims stack up to other specialties, open the report found in the link in the "References" section below. It is a PDF file so you can search for information on your specialty by using [Ctrl]+[F] to look for key terms like DME or "Family Practice". Also look at "Table D1: Top 20 Service Types with Highest Improper Payments: Part B".

To address documentation deficiencies, the ChiroCode DeskBook has been significantly revised for 2018 to help close this gap. Order yours today.

###

Questions, comments?

If you have questions or comments about this article please contact us.  Comments that provide additional related information may be added here by our Editors.


Latest articles:  (any category)

COVID Vaccine Coding Changes as of November 1, 2023
October 26th, 2023 - Wyn Staheli
COVID vaccine changes due to the end of the PHE as of November 1, 2023 are addressed in this article.
Medicare Guidance Changes for E/M Services
October 11th, 2023 - Wyn Staheli
2023 brought quite a few changes to Evaluation and management (E/M) services. The significant revisions as noted in the CPT codebook were welcome changes to bring other E/M services more in line with the changes that took place with Office or Other Outpatient Services a few years ago. As part of CMS’ Medicare Learning Network, the “Evaluation and Management Services Guide” publication was finally updated as of August 2023 to include the changes that took place in 2023. If you take a look at the new publication (see references below),....
Can We Score Interpretation of an EKG Towards E/M Medical Decision Making?
October 10th, 2023 - Aimee Wilcox
When EKGs are performed in the facility setting or even in the physician's office, what are the requirements for reporting the service and who gets credit for scoring data points for Evaluation and Management (E/M) medical decision making (MDM)? Let's take a look at a few coding scenarios related to EKG services to get a better understanding of why this can be problematic.
Accurately Reporting Signs and Symptoms with ICD-10-CM Codes
October 5th, 2023 - Aimee Wilcox
Coders often find themselves unsure of when to report a sign or symptom code documented in the medical record. Some coders find their organization has an EHR that requires a working diagnosis, which is usually a sign or symptom, be entered to order a test or diagnostic study or image. Understanding the guidelines surrounding when signs and symptoms should be reported is the first step in correct coding so let's take a look at some scenarios.
The 2024 ICD-10-CM Updates Include New Codes for Reporting Metabolic Disorders and Insulin Resistance
September 19th, 2023 - Aimee Wilcox
Diabetes is a chronic disease that just seems to consistently be increasing instead of improving resulting in a constant endeavor by medical researchers to identify causal effects and possible treatments. One underlying or precipitating condition that scientists have identified as a precipitating factor in the development of diabetes is insulin resistance, which is a known metabolic disorder. As data becomes available through claims reporting, additional code options become possible with ICD-10-CM.
Documenting and Reporting Postoperative Visits
September 12th, 2023 - Aimee Wilcox
Sometimes we receive questions regarding documentation requirements for specific codes or coding requirements and we respond with information and resources to support our answers. The following question was recently submitted: Are providers required to report postoperative services on claims using 99024, especially if there is no payment for that service? What documentation is required if you are reporting an unrelated Evaluation and Management (E/M) service by the same physician during the postoperative period? 
Understanding Gastroesophageal Reflux Disease and ICD-10-CM Coding
August 22nd, 2023 - Aimee Wilcox
Gastroesophageal reflux disease or GERD for short, is a disease that impacts millions of Americans on a weekly basis. Symptoms are uncomfortable, as are some of the tests used to diagnose it, but understanding the disease, tests, and treatments helps us better understand how to code the disease using ICD-10-CM codes.



Home About Terms Privacy

innoviHealth® - 62 E 300 North, Spanish Fork, UT 84660 - Phone 801-770-4203 (9-5 Mountain)

Copyright © 2000-2023 innoviHealth Systems®, Inc. - CPT® copyright American Medical Association