ICA Member News Update              

    August 4, 2004

 

NEW MEDICARE RULES TARGET CHIROPRACTIC UTILIZATION

 

New coding and claims submission rules that will go into effect on October 1, 2004 target "maintenance" care and seek to add new limitations on chiropractic services.  The official notice from the Centers for Medicare and Medicaid Services (CMS) provides only limited data, and alerts providers to be on the lookout for additional rules from regional carriers.  These new filing requirements represent another potential quicksand situation for chiropractors.

 

This is an important red flag for chiropractors since, in typical Medicare fashion,  DCs are told that "...your billing staff should be aware of any local policy (LMRP/LCD) for these services in your area that might limit the frequency or circumstances under which active/corrective chiropractic can be paid. If you exceed that limit, you shall not use the AT modifier."  There is no indication, however, of what that "limit" might be.  "It's like being told not to speed, but not being told what the speed limit is," said ICA Medicare Committee Chairman Dr. Michael Hulsebus.    "ICA has sought the assistance of Members of Congress to clarify the intent and hard parameters of the new rules, but urges all DCs providing Medicare services to be alert to the mandatory procedure changes," said Dr. Hulsebus.  "There is no doubt that the intent of these new procedures is to have a chilling effect on chiropractic utilization, and CMS' hope is to save money on chiropractic if only in the short term," said Dr. Hulsebus.  "We have every intention of fighting any additional unfair regulations and procedures, especially ones that seem to violate the 'no limits on clinically necessary care' pledge of the Medicare law."

 

ICA's Medicare Committee has also organized regional seminars to educate doctors on this new initiative, featuring Dr. Gary Street.  Watch future ICA updates for information about seminars in your area. 

 

The information published so far by CMS reads as follows:

 

"Chiropractors have been submitting a very high rate of incorrect claims to Medicare.  Medicare only pays for chiropractic services for active/corrective treatment (those using HCPCS codes 98940, 98941, or 98942). Claims for medically necessary services rendered on or after October 1, 2004, must contain the Acute Treatment (AT) modifier to reflect such services provided or the claim will be denied.

 

On or after October 1, 2004, when you provide acute or chronic active/corrective treatment to Medicare patients, you must add the AT modifier to every one of your claims that use HCPCS codes 98940, 98941, or 98942. If you don't add this modifier, your care will be considered maintenance therapy and will be denied because maintenance chiropractic therapy is not medically reasonable or necessary under Medicare. Additionally, your billing staff should be aware of any local policy (LMRP/LCD) for these services in your area that might limit the frequency or circumstances under which active/corrective chiropractic can be paid. If you exceed that limit, you shall not use the AT modifier.

 

Make sure that your billing staff are aware that they must apply the AT modifier to HCPCS codes 98940, 98941, or 98942 when your clinical documentation reflects that the care you provided to a Medicare patient consists of active/corrective treatment.

 

Chapter 15, Section 30.5 of the Benefits Policy Manual states that chiropractic maintenance therapy is not medically reasonable or necessary, and is not payable under the Medicare program.

 

Further, Medicare data indicates that chiropractors filed claims incorrectly almost a third of the time, ranking chiropractor claims among the highest Provider Compliance Error Rates in Medicare. To bill Medicare correctly, use the AT modifier for each claim you submit that is for active/corrective therapy.

 

For services rendered on or after October 1, 2004, all of your claims for active/corrective therapy (HCPCS codes 98940, 98941, 98942) that do not contain the AT modifier will be denied. Claims above your contractors' frequency limits must be billed without the AT modifier (you may still add the GA or GZ modifier as appropriate), and will be denied."

 

Important Dates to Know

Effective Date: October 1, 2004

Implementation Date: October 4, 2004

 

Related Instructions

For more information about using the AT modifier, consult Chapter 15, Section 30.5 and 240.1.3 of the

Benefits Policy Manual. In early October, you can access Chapter 15 at:

http://www.cms.hhs.gov/manuals/102_policy/bp102c15.pdf.

You can view this instruction before then at:

http://www.cms.hhs.gov/manuals/future.asp

Also, you may check any LMRP/LCDs that may apply to you at:

http://www.cms.hhs.gov/mcd.

 

 

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For More Information: Contact the International Chiropractors Association at:  chiro@chiropractic.org or visit the ICA website at www.chiropractic.org. 

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