Medicare Violators: Good Apples in a Bad System?
Dear Editor:
I would not have chosen the title, "Targeting Bad Apples in the Bunch," for the Nov. 15 article covering an OIG report on chiropractic Medicare payments, because it insinuates the chiropractors with allegedly questionable or improper paid claims are somehow of rotten character and of bad conduct.
The fact that most chiropractic offices are small clinics with limited billing and administrative resources is probably a confounding variable impacting the reported lack of compliance with the Medicare program and its unique set of rules. This is in sharp contrast with corporate medicine, which has large clinical practices with enormous billing resources that constantly check and double check coding and documentation to ensure meeting the ever-changing sea of insurance regulations, including Medicare.
Most chiropractors probably do not have this type of high-quality support, nor did they have a Medicare-funded residency program in which they could train for many years under the watchful eye of an attending physician and learn standardized documentation practices from an established hospital organization.
To characterize the use of incorrect codes and insufficient documentation in the Medicare program as bad conduct may be a bit myopic. Medicare demands are more stringent than the other commercial insurance entities. In addition, Medicare places the DC at a disadvantage to the MD provider. We are restricted in diagnosis, restricted in procedures and do not get the same practice opportunities as our medical counterparts.
Perhaps one of the hardest conversations a chiropractor has with a Medicare patient is when the DC needs to perform an examination or therapies Medicare will not pay for, meaning these services will be the patient's responsibility to pay. Couple that disclosure with the fact that the patient may need X rays Medicare will not pay for if they are ordered by the DC, and this may be enough to discourage the patient from establishing a relationship with the chiropractor from the start.
If a provider feels sorry for the elderly patient and tries to make some economic exceptions, the doctor may be accused of trying to induce the patient into treatment. Furthermore, a DC cannot opt out from the Medicare program and treat patients under private contract, outside the Medicare program, like the medical provider can.
In my opinion, Medicare full funding of residency programs for chiropractors would improve the integration of DCs with corporate medicine and help improve compliance with the Medicare rules. Additionally, leveling the playing field and allowing doctors of chiropractic to opt out of Medicare and treat patients under a private contract agreement, as many medical providers do, would avoid these compliance issues and allow the DC to treat these patients without restrictions in a more competitive and efficient way.
Robert Jusino, DC, JD
River Forest, Ill.
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