INSURANCE


OIG Reports on Chiropractic

Since 1973, Medicare has covered manual manipulation of the spine for the treatment of certain neuromusculoskeletal conditions. To get paid, chiropractors are supposed to (a) specify the region of the spine where the supposed problem exists, (b) diagnose a medically recognized condition that is related to that spinal region, (c) document symptoms, physical findings, and/or …

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American Specialty Health Network Excludes Many “Complementary” Methods

American Specialty Health, Inc. (ASH) has published detailed clinical practice guidelines for 74 “complementary” techniques and procedures, most of which are used mainly by chiropractors. The documents indicate: None of these methods would not be covered under the plan because they are considered unsubstantiated, unsafe, or both. 71 of the methods are classified as experimental …

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Alberta Expert Advisory Panel Report on Chiropractic

The mission of Alberta’s Expert Advisory Panel is to ensure that the province’s publicly funded health services remain comprehensive, sustainable, and good value. The panel’s most important considerations are effectiveness and cost-effectiveness. The chiropractic section of its first progress report (shown below) expressed concern about rising costs and recommended that chiropractic services be limited to …

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Chiropractic Services in the Medicare Program: Patient Vulnerability Analysis

To determine the underlying causes of, and potential ways to reduce, vulnerabilities associated with Medicare payments for chiropractic services. Background In 1972, Congress passed Public Law 92-603, which amended section 1861(r) of the Social Security Act (the Act) to define chiropractors as physicians who are eligible for Medicare reimbursement, but only for manual manipulation of …

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Medicare Chiropractic Billing Policies Revised

The Center for Medicare and Medicaid Services (CMS) has revised its requirements for chiropractic billing of “active/corrective” treatment and “maintenance” therapy [1]. Under the Medicare program, active therapy (AT) is a course of treatment that provides “reasonable expectation of recovery or improvement of function” whereas maintenance therapy is defined as: A treatment plan that seeks …

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Be Wary of “No Out-of-Pocket Expense” Offers

It is illegal to routinely excuse patients from insurance copayments and deductibles. (A copayment is a fixed dollar amount paid whenever an insured person receives specified health-care services. A deductible is the amount that must be paid before the insurance company starts paying.) It is legal to waive a fee for people with a genuine …

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