Thursday, June 23, 2005

I know I'm opening a can of worms....

Billing Medicare for services rendered can be a difficult process --- there are unending rules, difficult to meet or understand documentation requirements, conflicting regulations, and a coding system that does not cover all conceivable situation. So, when the news media reports that one entity or another has been audited and accused of Medicare fraud, I am often skeptical.

However, this article caught my attention because, in all honesty, I am biased.

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.
For some time, I have tried to get a handle on exactly how much money is being spent by Medicare and Medicaid on chiropractic services. I have downloaded the 39 page report this article is based upon, and hope to come up with a reasonable answer. What may be harder to discover is how much money is spent on chiropractic care by private insurers --- for example, we recently switched health insurance coverage for our physicians and staff. The state requires that health insurance cover chiropractic care, and we were therefore unable to purchase "chiropracticless" coverage; this type of rule drives up costs for all of us.

I'm sure I'll have more to say after I've read the whole thing.