The CMS has not implemented a prior authorization process for chiropractic services even though federal law required that move, according to the U.S. Government Accountability Office.
Under MACRA, the CMS had to impose prior authorization for chiropractic services on or after Jan. 1, 2017. The rate of improper payments for these services fluctuated between fiscal 2014 to fiscal 2017, reaching a high of 54.1%, or about $304 million, and a low of 41.7%, or $235 million, according to a July 31 GAO report.
Although improper payments are decreasing, chiropractic services still have a higher rate compared with the overall improper payment rate for the Medicare, which was 9.5% in fiscal 2017.
HHS' Office of Inspector General has said that chiropractic services has the highest rate of improper payments among Medicare Part B services.
Improper payments include fraudulent claims, payments distributed to the wrong recipient or for the wrong amount, payments with insufficient documentation and issues where the recipient uses the funds improperly.
The CMS didn't offer an explanation to GAO officials about the delay to launch prior authorization. Instead, it will issue proposed rulemaking in December to move forward with the process.
A CMS spokesman didn't immediately return a request for comment.
The CMS has also spent the past few years developing additional educational material for chiropractors. It has published a series of educational articles on topics ranging from Medicare's rules for coverage and medical record documentation.
It also published a 20-minute video on its YouTube channel in which CMS officials answer questions about billing requirements for chiropractic services.
The agency developed these materials to comply with another MACRA requirement to ramp up educational and training efforts for chiropractors.
