As demonstrated by the beautiful casinos in Vegas….You can’t beat the system forever.
Medicare has expressly defined maintenance care and clearly stated it is a non-covered service. Nevertheless, many chiropractors have tried to beat the system and bill for maintenance care (as defined by Medicare—a practice management company’s definition is not relevant!).
From the May, 2009 OIG (Office of the Inspector General) Medicare Report
- In 2006, Medicare inappropriately paid $178 million (out of
$466 million) for chiropractic claims for services that medical reviewers
determined to be maintenance therapy ($157 million), miscoded
($11 million), or undocumented ($46 million). - 47 percent of all allowed chiropractic claims that met study criteria.
Claims representing $36 million had multiple errors - Efforts to stop payments for maintenance therapy have been largely ineffective.
- 78 percent of those treatment episodes that became maintenance therapy did so by the 20th visit.
- Chiropractors often do not comply with the Manual documentation requirements.
