Chiropractic Services: High Improper Payment Rate within Medicare FFS Part B

The Office of Inspector General (OIG) recently released a 2016 Final Report on Medicare payments for chiropractic services. There were approximately $389 million in improper payments for chiropractic services during the 2013 reporting period; most payments did not comply with Medicare requirements. The OIG attributed the improper payments to services that were medically unnecessary, incorrectly coded, insufficiently documented, or not documented to support the billed services.

Understand Medicare requirements for chiropractic services, especially documentation and medical necessity. Resources:

Resources:

• Hundreds of Millions in Medicare Payments for Chiropractic Services Did Not Comply with Medicare Requirements OIG Report October 2016
• Chiropractic Education webpage
• Improving the Documentation of Chiropractic Services Video: Learn about medical necessity and proper documentation
• April 2013 Medicare Quarterly Provider Compliance Newsletter: Article on chiropractic claims

MLN Matters® Articles:

• Overview of Medicare Policy Regarding Chiropractic Services
• Medicare Coverage for Chiropractic Services: Medical Record Documentation Requirements for Initial and Subsequent Visits
• Use of the AT Modifier for Chiropractic Billing 
• Educational Resources to Assist Chiropractors with Medicare Billing