December 5, 2014 — Legislation introduced in the U.S. House of Representatives this week calls for the Secretary of Health and Human Services to develop an education program to help improve documentation in chiropractic Medicare claims. The bill stipulates that the program would be created in consultation with the American Chiropractic Association (ACA) and representatives of Medicare administrative contractors and be made available by Jan. 1, 2016.
The Protecting the Integrity of Medicare Act (PIMA), H.R. 5780, is part of HHS’ ongoing, system-wide effort to reduce Medicare claim error rates and to prevent fraud. Under the bill, DCs whose claim denial rates are clearly out of line with the rest of the profession could be subject to pre-authorization standards, established by HHS. Doctors of chiropractic with a good record of claims based on proper documentation and those who avail themselves to the education program will avoid pre-authorization requirements that non-compliant providers could eventually face.
“While this legislation may appear to be an indictment against the chiropractic profession, comparative data from 2011 shows us at the top of the error rate list at 44.1 percent. We can no longer make the assertion that we are being discriminated against,” ACA President Anthony Hamm, DC, said. “Frankly, should this legislation be enacted, it will provide ACA the opportunity to educate those who are not compliant with clinical decision making and documentation of the Medicare patient. It will also potentially offer us the opportunity to interact with CMS and the individual Medicare Administrative Contractors to provide a better understanding of our unique model of patient care.”
“ACA is working hard to ensure that the vast majority of DCs that are compliant with proper documentation and clinical decision making skills are not penalized in ways that harm them or their doctor-patient relationships,” Hamm added.
The bill currently has no companion legislation in the Senate, but it could possibly be attached to other, larger legislation expected to move forward in the House later this year. ACA will continue to monitor the bill’s progress and oppose any overly burdensome pre-authorization requirements. DCs can learn more about documentation requirements by visiting www.acatoday.org/Medicare.