Newsletter

Comparative Billing Report and Chiropractic Error Rate in Medicare
Please share this info with other D.C.'s

Updated: November 1, 2010
Dear Doctors and Staff,

CMS has significantly revised and improved the way that it calculates the Medicare fee-for-service error rate. The improved methodology provides a more accurate assessment of unsubstantiated claims. The improvements are consistent with recommendations CMS has received from the Office of Inspector General (OIG).

This year's error rate is higher than last year's: 7.8 percent compared to 3.6 percent in FY 2008. One of the two areas of significant increase in errors was inpatient services.

CMS implemented three separate revisions to the Medicare review criteria to more strictly enforce Medicare policies. The primary modification required the medical reviews under CERT to strictly follow the documentation requirements outlined in Medicare regulation, statute and policy, including Local Coverage Determinations (LCD's), rather than allow for clinical review judgment based on billing history and other information.

A significant portion of the new errors found in FY 2009 were due to a strict adherence to policy documentation requirements, signature legibility requirements, the removal of claims history as a valid source of review information, and the determination that medical record documentation received only from a supplier is, by definition, insufficient to substantiate a claim.

If you are not "documenting" the Chiropractic necessity of care by Federal Standards, it is not acceptable as a payable claim. Because 47% of Chiropractic claims billed in 2009 were not documented correctly and were inappropriately paid, CMS wants $178 million BACK.

The Comparative Billing Report that a large number of Chiropractors received by fax from SGS CBR Services, gives to you your Medicare statistics in comparison to your peer's. Because Chiropractors error rate is so high, CMS strongly suggests you are out of norm if you see and bill a Medicare patient more than 12 visits per year.

CMS says, 47% of the money paid to Chiropractors was paid inappropriately to the tune of $178 million. The problem is that most Chiropractors do not know how to document the Chiropractic "Necessity of Care". They think everything is ok becuase they bill Medicare and the Medicare carrier pays. However, Chiropractors are being audited that don't know how to"Document" correctly by Federal Standards, and CMS is coming to get their money back!
BOTTOM LINE: If you wish to learn how to do Chiropractic Medicare correctly, including "documenting" by federal standards, please consider ordering our Chiropractic Medicare DVD and booklet. It explains piece by piece every important step in doing and billing Chiropractic Medicare so there are no limits for the chiropractic adjustment. If you are audited you will have done Medicare correctly and win your audit. You and your staff will be very happy you have this important and mandatory information. I promise it will make a difference in your understanding of Medicare and how you bill Medicare.
Seminar Schedule
Keep in mind, Medicare is the only insurance type program that if done incorrectly is fraud, a felony, a fine and/or jail.

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I promise you will be more than satisfied that you made the right decision to purchase this information or attend our presentation. Please give me a call if you have questions. 1-618-395-3162

Best regards,
Dr. Gary R. Street


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