The American Chiropractic Association and Congress of Chiropractic State Associations were quick to offer comment once President Obama put his signature on H.R. 2, the Medicare Access and CHIP Reauthorization Act of 2015 (see our top story in this edition). Both organizations issued releases focusing on provisions in the new legislation that impact doctors of chiropractic as outlined in Section 514: Oversight of Medicare Coverage of Manual Manipulation of the Spine to Correct Subluxation. As noted by COCSA, Section 514 "singles out the chiropractic profession for medical review of spinal subluxation services; possible prior authorization; and increased efforts to improve documentation of services."
"The ACA fought diligently for the main thrust of the legislation's attempts to reduce the claims error rate to be built around a useful program of education and training, rather than to have the legislation impose an across-the-board pre-authorization requirement that would automatically apply to all DCs providing services under Medicare – and we succeeded in doing that," said Dr. Anthony Hamm, ACA president stated.
According to the association (which is officially named in the law), the ACA "will work with HHS and Medicare Administrative Contractors to develop and implement an in-depth education and training program available to all DCs. The purpose of this provision is of course to reduce the claims error rate and improve claims documentation skills across the entire profession. This training program established under the law is scheduled to commence no later than January 1, 2016."
"It is the intention of the ACA to make cooperating state associations 'full partners' working with us to ensure that Medicare claims error rates are reduced to an acceptable level.," added John Falardeau, ACA senior vice president for government relations.
Section 514 details the review / authorization process applicable to doctors of chiropractic as follows:
"The Secretary shall implement a process for the medical review (as described in paragraph (2)) of treatment by a chiropractor described in section 1861(r)(5) by means of manual manipulation of the spine to correct a subluxation (as described in such section) of an individual who is enrolled under this part and apply such process to such services furnished on or after January 1, 2017, focusing on services such as:
(A) services furnished by such a chiropractor whose pattern of billing is aberrant compared to peers; and
'(B) services furnished by such a chiropractor who, in a prior period, has a services denial percentage in the 85th percentile or greater, taking into consideration the extent that service denials are overturned on appeal."
COCSA Comments
The Congress of Chiropractic State Associations weighed in on Section 514 with the following statement from Dr. John LaMonica, COCSA president:
"Section 514 has been the subject of much discussion and negotiation at the national level. We are hopeful that the result of these negotiations will be that the members of the Chiropractic Summit Steering Committee will work together to address the concerns regarding Section 514 and cooperate in any and all legal, legislative, administrative, and educational efforts undertaken regarding the new law.
"Additionally, we are working to assure that the Summit Steering Committee agrees to jointly develop and disseminate any educational programs and initiatives developed in response to Section 514. The COCSA Board of Directors and member organizations look forward to working with the Chiropractic Summit Steering Committee and other stakeholders in a unified voice for the improvement and protection of the chiropractic profession."
The MIPS Provision
In the ACA's release, the association also commented on the Merit-Based Incentive Payment System (MIPS), another provision of H.R. 2 relevant to doctors of chiropractic:
"Beginning in 2019, the three existing quality incentive programs – Physician Quality Reporting System (PQRS), Electronic Health Reporting (EHR) Meaningful Use and the Value-Based Modifier – will be consolidated into one cohesive program that streamlines reporting and avoids redundancies. Future payments will be adjusted based on provider performance in four categories: quality, resource use, EHR meaningful use, and clinical practice improvement activities."
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