Federal Regulation news
The Sep 2015 OIG Report: Inappropriate Payments
Written by Editor   
Monday, November 09, 2015 11:40 AM

In September of 2015 the Office of the Inspector General (OIG) of the Department of Health and Human Services, a federal agency, released a report highlighting its evaluation of chiropractic claims and questionable and inappropriate payments for chiropractic services. This article looks at the findings of the OIG study.

“We developed three measures to identify paid claims that did not meet Medicare requirements for payment,” the OIG report states.  These are noted to be claims lacking a covered primary diagnosis; claims for duplicate services; and claims lacking the AT modifier.

Claims lacking a covered primary diagnosis were "claims that lacked a primary diagnosis code that was covered by Medicare based on CMS’s guidance and the local coverage determination where the chiropractic service was provided.”  There were found to be 808,971 claims or 4.1% of total Medicare paid claims meeting this description.

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Medicare Cut for Physicians Helps Balance New Budget Deal
Written by Editor   
Tuesday, November 03, 2015 09:06 AM

A bipartisan, 2-year budget deal that averts a default on federal debt, keeps the government running, and relaxes automatic spending limits hinges in part on a future Medicare pay cut for physicians.

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The Sep 2015 OIG Report:  Questionable Payments
Written by Editor   
Monday, November 02, 2015 08:05 AM

In September of 2015 the Office of the Inspector General (OIG) of the Department of Health and Human Services, a federal agency, released a report highlighting its evaluation of chiropractic claims and questionable and inappropriate payments for chiropractic services. This article looks at the findings of the OIG study, specifically their determination of “questionable payments.”  How does the OIG determine which paid claims are questionable? This article reports the criteria that the OIG used to determine if a claim was questionable. 

The OIG states “we developed four measures to identify paid claims that were questionable.  We based these measures on previous OIG reports and fraud investigations, interviews with experts in chiropractic practice and fraud detection, and our own analysis."

These measures include “treatment suggestive of maintenance therapy”, “potentially uploaded claims”, “potential sharing of beneficiaries”, and an “unlikely number of services per day."

Says the OIG “a high average number of claims per beneficiary per chiropractor suggests billing for services that were not active treatment.”  The OIG has observed that the more services that are provided to a beneficiary, the more likely it is that the services are medically unnecessary or maintenance treatment.  “We determined that 20 services per beneficiary was the threshold for this measure.  We identified as an outlier any chiropractor whose average number of paid claims per beneficiary exceeded the threshold.  For these chiropractors, we identified their beneficiaries who had treatments in excess of the threshold and considered all claims associated with these beneficiaries to be questionable.” 

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Researchers Confirm Presence of MicroRNAs in Dried Bovine Tissue
Written by Editor   
Monday, November 02, 2015 04:10 AM

Researchers at Standard Process Inc. recently published a paper confirming the survival and diversity of human homologous dietary microRNAs (miRNAs) in cooked and dried bovine tissue extracts. The paper, “Survival and Diversity of Human Homologous Dietary MicroRNAs in Conventionally Cooked Top Sirloin and Dried Bovine Tissue Extracts,” published by PLOS ONE, a multidisciplinary open access journal, concludes that edible bovine tissues contain unique profiles of human homologous dietary miRNAs that survive thermal processes.

The research, conducted by the research and development team at Palmyra, Wisconsin-based Standard Process, is the first known research into the characterization and survivability of miRNA in processed consumable products of animal origin. To date, miRNA research has only examined the effect of miRNAs in milk and plant-based food. Little research exists on the profile of miRNAs in beef, which is consumed by millions of people worldwide, or in bovine tissue extracts used as ingredients in dietary supplements.

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National Campaign Seeking Full Physician Status in Medicare Program
Written by Editor   
Thursday, October 29, 2015 11:49 AM

The American Chiropractic Association (ACA) has launched a national grassroots effort to eliminate anti-competitive provisions of Medicare law that arbitrarily limits reimbursement for medically necessary services delivered by doctors of chiropractic (DCs).  The statutory change would define DCs as "physicians" under Section 1861 of the Social Security Act for the provisioning of any existing Medicare covered service that falls within the scope of practice of an individual DC as defined by their applicable state law.

ACA will focus on generating a robust level of patient grassroots support aimed at Congress seeking to ensure that Medicare beneficiaries have full access to covered services that are legally provided by chiropractic physicians. Grassroots support will be largely generated via a National Medicare Equality Petition that will raise awareness of how the current Medicare system shortchanges seniors  needing the essential services provided by DCs.

 To support the campaign:  

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