Chiropractors Face Medicare Audits

In 2010, president Obama issued an Executive Order designed to reduce waste, payment errors, fraudulent practices, and abuses within government programs. It mandated that federal agencies perform studies twice a year as a means of identifying and reducing potential vulnerabilities in areas of the system where there was suspected to be a greater likelihood of mistakes or abuse.

In the wake of this announcement, chiropractors across the nation began receiving Medicare audit notices with requests for patient records targeted for verification. If you have been a recipient of one of these letters, it is critical that you begin to prepare to respond immediately, and obtaining the services of an experienced RAC Audit Lawyer can make the process much smoother and less stressful.

The studies are part of the Comprehensive Error Rate Testing (CERT) program of The Centers for Medicare & Medicaid Services (CMS), and where chiropractic care is concerned they focus on examining the practices of chiropractors known to have filed for the same Medicare beneficiary multiple claims during a designated sample time period. This is where an RAC Audit Lawyer can assist you with organizing and preparing an adequate defense that support and clarifies your actions.

The primary aspect of the chiropractic services study involves examining patient records back one full year from the date of service. Since Medicare pays only for treatment deemed to be medically necessary, any continuing care received where further improvement was not expected, would be considered maintenance care and not covered by Medicare.

For each case, CMS will decide whether or not the services for which Medicare was billed qualified as acute medically necessary chiropractic care, and if not the claims will be denied and CMS will demand reimbursement for any overpayments. As this can equate to a substantial sum, it is another reason to contact an RAC Audit Lawyer who specializes in recovery audits and representing and protecting your interests.

Dr. Tom Neela, a professional medical auditor, advises chiropractors who have received audit letters to promptly reply to the records request even if the documentation is not in perfect order. Failure to respond within 30 days can result in an automatic denial of claims, charges of fraud, or other violations. So don’t put off complying with the audit. Instead, contact an RAC Audit Lawyer who can provide assistance and answer all of your questions.

Once the assessment is complete, you will want to review your practice to avoid future audits or a repeat of any errors that might have been identified. An RAC Audit Lawyer will be happy to evaluate your current situation to advise you as to what measures you should take to ensure you’ll be ready and in compliance if ever audited again.


April 26th, 2011