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 Consulting 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. For example, the average improper payment rate for Medicare Part B services has been estimated at between 9.9%-12.9%. For chiropractic services, the improper payment rate has been estimated to be between 43.9%-54.1%. About half of all chiropractic services covered by Medicare were not supposed to be covered. The OIG has estimated that of the nearly $450 million spent by Medicare on chiropractic services every year, between $257 million and $304 million in improper payments are being made every year for chiropractic services. (CMS’s Supplementary Appendices for the Medicare Fee-for-Service Improper Payment Reports for 2010–2015.) Over a six-year period, $2.9 billion was spent by Medicare on chiropractic services. Theoretically, this means that at least $1.27 billion was wasted over those six years. One can be reasonably sure that this also transfers over in some aspect to standard insurance plans receiving chiropractic claims.
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 physical medicine 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 and improper coding is another area that needs attention. 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 Consulting Services?
Dr. David Boll's Comprehensive Consulting 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 Consulting 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 benefits that are reasonable, related and necessary, please contact me to discuss how I can assist.