For years, the imposition of the SGR payment formula threatened to produce unsustainable reductions in Medicare payment levels for all Medicare providers. Congress was repeatedly forced to enact a series of temporary “patches” to avoid the full brunt of the payment reductions from taking place. “I am pleased to see this flawed system, in place for nearly 20 years, eliminated. Now chiropractic physicians don’t have to fear double digit cuts in reimbursement every year,” said American Chiropractic Association (ACA) President Anthony Hamm, DC. “Congress has danced around this issue for far too long, and it is in the profession’s best interest that it has finally been addressed.” 

Also included in the legislation is a provision directing the U.S. Department of Health and Human Services (HHS) to develop an education program to help improve documentation in chiropractic Medicare claims. The provision stipulates that the program would be created in consultation with ACA and Medicare Administrative Contractors (MACs) and implemented by Jan. 1, 2016. This is part of an ongoing federal effort to reduce Medicare claim error rates.

Under the provision, DCs whose claim denial rates are out of line with the rest of the profession could be subject to pre-authorization standards established by HHS. DCs 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.

“This provision will provide ACA the opportunity to educate those who are not compliant with clinical decision-making and documentation of the Medicare patient,” explained Dr. Hamm. “At the same time, it will also offer ACA the opportunity to better interact with CMS and the individual MACs to provide a better understanding of our unique model of patient care.”

Another provision of interest to the profession is the Merit-Based Incentive Payment System (MIPS). Beginning in 2019, the three existing quality incentive programs — Physician Quality Reporting System (PQRS), EHR Meaningful Use and the Value-Based Modifier — will be consolidated into one cohesive program that streamlines reporting and avoids redundancies. Future payments will be adjusted based on provider performance in four categories: quality, resource use, EHR meaningful use, and clinical practice improvement activities.

“ACA worked hard to assure that DCs were included in this vital new program. With quality reporting about to become the lynchpin of Medicare reimbursement, it is essential that chiropractic physicians are included,” added Dr. Hamm. “All of this does not preclude ACA’s goal of achieving full parity for chiropractic physicians in the Medicare program. Our work continues with Congress and the Obama administration to demonstrate that chiropractic physicians can serve Medicare patients in an efficacious and cost-effective manner.” 

The legislation was sent to the White House, where the President is expected to sign it.

DCs can learn more about Medicare and Medicare documentation requirements by visiting www.acatoday.org/Medicare.