There is no need to set a policy to deny all claims for items and services from chiropractors since the bulk of incorrect payments are already blocked, the Centers for Medicare & Medicaid Services said this week, bucking a recommendation from a government watchdog agency.
Medicare contractors should recover a part of the $6.7 million in overpayments to chiropractors, the Office of Inspector General for Health and Human Services recommended in its July report titled “Medicare Improperly paid providers for items and services ordered by chiropractors.” In addition, the contractors should tell providers of potential overpayments so that these providers can investigate such claims and return any improper funding.
CMS agreed but did not concur with another recommendation: that the agency should start denying all claims for items and services ordered by chiropractors. It reasons that the majority of improper payments relate to imaging services, durable medical equipment or home health, which are already denied.
In its breakdown of a review of almost 66,000 claims ordered by chiropractors in calendar year 2013, the OIG said more than half were for imaging services, coming at a cost of $2.6 million.
CMS began sending an informational message in 2009 alerting a billing provider when a
National Provider Identifier of an ordering provider were invalid, or that the ordering provider wasn’t allowed to order an item or service, such as a chiropractor ordering imaging. But CMS but didn’t start denying claims until January 2014, the OIG said. Of the $6.7 million incorrectly billed, 89% was in calendar year 2013, OIG investigators said.
This marks the second time this year the OIG has hammared the agency on improper Medicare payments for chiropractors.