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GAO-18-624R 1 (2018-07-31)

handle is hein.gao/gaobacpoh0001 and id is 1 raw text is: GAOU.S. GOVERNMENT ACCOUNTABILITY OFFICE 441 G St. N.W. Washington, DC 20548 July 31, 2018 Congressional Committees Medicare: Status of HHS's Implementation of Required Prior Authorization Medical Reviews and Provider Education for Chiropractic Services In fiscal year 2016, Medicare spent approximately $540 million on chiropractic services. This represents less than 1 percent of the nearly $700 billion Medicare spent for health services for its 57 million elderly and disabled beneficiaries.1 Chiropractic services focus on the diagnosis and treatment of disorders of the musculoskeletal system, especially the spine, and Medicare pays for certain treatments involving manual spinal manipulations.2 In fiscal year 2016, about 44,000 health care providers submitted claims to Medicare for chiropractic services provided to beneficiaries. The Centers for Medicare & Medicaid Services (CMS)-an agency within the Department of Health and Human Services (HHS)-is responsible for administering the Medicare program and ensuring that the services for which it pays, including chiropractic services, are reasonable and medically necessary. Chiropractic services have a relatively high rate of improper payments, although this rate has declined in recent years and the amount represents a small percentage of the overall Medicare fee-for-service improper payment amount.3 From fiscal year 2014 to fiscal year 2017, the Medicare improper payment rate for chiropractic services decreased from approximately 54.1 percent (or about $304 million) to an estimated 41.7 percent (or about $235 million).4 The improper payment rate for chiropractic services, however, remains high compared to the overall improper payment rate for the Medicare fee-for-service program, which was estimated to be 9.5 percent (approximately $36.2 billion) in fiscal year 2017. The improper payment amount for chiropractic services is also a small percentage (less than 1 percent) of the overall Medicare fee-for-service improper payment amount. According to CMS in 2016, the majority of the errors for chiropractic services are due to insufficient documentation or other documentation errors. 1Boards of Trustees, Federal Hospital Insurance and Federal Supplementary Medical Insurance Trust Funds, 2017 Annual Report of The Boards of Trustees of the Federal Hospital Insurance and Federal Supplementary Medical Insurance Trust Funds (Washington, D.C.: July 13, 2017). 2Medicare pays for a subset of chiropractic services-specifically, services involving active and corrective spinal treatments. 3An improper payment is any payment that should not have been made or that was made in an incorrect amount (including overpayments and underpayments) under statutory, contractual, administrative, or other legally applicable requirements. It includes any payment to an ineligible recipient, any payment for an ineligible service, any duplicate payment, payment for services not received (except where authorized by law), and any payment that does not account for credit for applicable discounts. See Improper Payments Information Act of 2002, Pub. L. No. 107-300, 116 Stat. 2350, as amended and codified at 31 U.S.C. § 3321 note. 4Department of Health and Human Services, 2017 Medicare Fee-for-Service Supplemental Improper Payment Data, (Washington, D.C.: January 2018); Department of Health and Human Services, The Supplementary Appendices for the Medicare Fee-for-Service 2014 Improper Payments Report, (Washington, D.C.: December 2014). GAO-1 8-624R Medical Reviews of Chiropractic Services Page 1

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