July 2005

ACA Announces New Action Plan in
Wake of Inspector General Report

The American Chiropractic Association intends to challenge the June 21 report by the Office of Inspector General (OIG) of the Department of Health and Human Services.

The OIG report stated that approximately 67 percent of the chiropractic services allowed by Medicare in 2001 did not meet Medicare coverage criteria, were miscoded, or were undocumented, and resulted in $285 million in improper payments.

The ACA Board of Governors voted at its July 5 meeting to form a special committee to review all aspects of the OIG report, determine the true magnitude of the problems identified, and — if any of the findings regarding documentation errors are valid — develop workable measures that would substantially respond to the OIG report.

The OIG concluded that much of the care provided consisted of “maintenance therapy,” which is not covered as a benefit under the Medicare program, and that the Centers for Medicare and Medicaid Services (CMS) should take effective steps to eliminate inappropriate reimbursement of chiropractic care within the Medicare program.

The report contained a specific recommendation that CMS impose “national frequency based controls” in order to reduce inappropriate payment of chiropractic care.

Total reimbursement for all chiropractic care provided under Medicare in 2001 amounted to $500 million. With total Medicare spending estimated at $242 billion that year, chiropractic care represented approximately 0.2 percent of overall Medicare expenditures.

The ACA special committee will examine all facets of the IG report, including the methodology used and the justification for the conclusions that were drawn. ACA officials say it is too early to predict what specific remedies, if any, the special committee will devise and seek to implement. They said that the work of the committee will likely involve the input of other key parties, such as chiropractic colleges, state associations and state licensing boards.

Since 2001 (prior to the release of the OIG study), ACA formed its Clinical Documentation Committee to create a documentation manual specifically for chiropractors. The association released its Clinical Documentation Manual earlier this year.

Source: American Chiropractic Association, www.acatoday.com

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