ACA Medicare Advisory Board: Parity Growing Pains Don’t Have to Be a Pain in the Neck

By Cassie LaJeunesse posted 05-12-2021 10:14


By the ACA Medicare Advisory Board

As ACA moves closer to parity with the reintroduction and bipartisan support of H.R. 2654, it is only natural to begin thinking of an equitable (not-so-distant!) future in which doctors of chiropractic are able to bill to the full scope of their licensure in Medicare. Along with long-overdue coverage for American seniors seeking nondrug alternatives for pain, parity would also bring some growing pains in terms of billing and coding. ACA staff, leadership and members who serve on committees and advisory boards have been planning for this and are continuously preparing for the time when H.R. 2654 is law.

Recently, a robust discussion was held on the MyACA forum and highlighted just how important it is that the profession remain connected and continue to learn from one another. The benefit of a robust government relations team is that ACA has a handle on not just Congress, but the executive branch as well. While legislative advocacy is exciting and easily accessible, regulatory work and engagement with executive branch agencies like the Centers for Medicaid and Medicare Services (CMS) are just as critical to advance the chiropractic profession and address concerns like those raised on the forum.

The forum discussion concerned the revised annual version of the CMS National Correct Coding Initiative (NCCI) Policy Manual for Medicare Services and asked if the 2021 edits would prevent payment for an exam and manipulation during the same chiropractic visit. While the answer is no, the surrounding discussion highlights the value of ACA’s proactive advocacy strategy. It is important to note that NCCI edits are not permanent; they impact all healthcare specialties and undergo periodic review. Furthermore, the prior OIG report was unfavorable in reporting on chiropractic documentation. As a profession, it is critical that we do our part to improve our fraud, waste and abuse profile so that we can minimize the potential for unfavorable edits in the future. The time is now, and the power is ours to shape the chiropractic profession for generations to come. We owe it to our patients.  

ACA is well equipped, especially with the support of our engaged and active members, to confidently move towards a time of parity and equity for all chiropractic patients. Further, CMS coding and billing will not hold back implementation of Medicare parity. We are confident that such potential hiccups can and will be resolved when the time comes.