The current status of health care in America demands that companies pay for only those services that are necessary and supported and meets their plan/policy language. Through my consulting and review company, Comprehensive Chiropractic Services (CCS), I can assist your company in navigating the physical medicine health care arena.
Headlines and studies show that an unnerving trend in unnecessary health care services are being submitted and your company is paying for these unsupported claims right now.
Why do you need someone looking over your chiropractic claims?
The news stories speak for themselves. Health care fraud makes the news nearly every day. Clinics having unlicensed staff render therapies, billing for patient visits that were not rendered, billing for services not documented and the list goes on. The Centers of Medicare & Medicaid Services noted that 45% of claims in a recent year had insufficient documentation to support services. An estimated $17 billion to $57 billion was lost due to Medicare fraud in 2012. Medicare spent $359 Million on unnecessary chiropractic care alone in 2013, based on an audit. The investigation found that all chiropractic care after the first 30 treatments was unnecessary, according to a federal review, and that more than 80% of the money that Medicare paid to chiropractors in 2013 went for medically unnecessary procedures. (Wall Street Journal, Oct. 19, 2016)
In 2007, $2.26 trillion was spent on health care, 3 percent of which (approximately $68 billion), according to National Healthcare Anti-Fraud Association (NHCAA) estimates,was attributable to health care fraud. FBI estimates are even higher, placing losses due to health care fraud as high as 10 percent of our nation's annual health care expenditures - a staggering $226 billion each year.
It’s more than that though. Blatant, pre-meditated fraud does take its toll, but what about those ongoing and unending treatment plans you see from chiropractic offices, without any plan, goals, re-exam findings or any discharge. It’s not unusual to see cases where several adjunctive services are rendered throughout without any proper case management or reduction to support the service was necessary and beneficial. Those areas need to be addressed.
Incorrect coding is another avenue for a clinic to increase collections. This can be a “soft fraud” area. Many chiropractors upcode the manipulative service based on their technique choice or professional philosophy, neither of which are valid. The Office of the Inspector General has examined chiropractic claims and in one study found an 87% error rate in regards to improperly coding the chiropractic manipulation (CMT CPT codes 98940, 98941 and 98942). Are you getting improper coding billed to your office? Do the records support the level of service being rendered?
Unnecessary and unsupported chiropractic care is costing your company thousands of dollars, possibly tens to even hundreds of thousands of dollars.
"Insurance Fraud, It's all over the place and you should care about it"- Omaha World-Herald
Why choose Comprehensive Chiropractic Services?
Dr. David Boll's Comprehensive Chiropractic Services, as an independent contractor, is available to aid your company in the implementation of guideline development, processing procedures, internal education and performing medical necessity paper reviews for all aspects of chiropractic health care claims. Provider network credentialing, thorough screening and ongoing network management services are also available.
Comprehensive Chiropractic Services/ Dr. David Eric Boll’s Qualifications:
What does your company reap as a benefit?
If your company wants to save money and pay for only those chiropractic benefits that you should, please contact me to discuss how I can help you with your chiropractic claims