CMS missed deadline to create MACRA-mandated chiropractic preauthorizations, GAO says

GAO's report may have been painful for CMS to read. (Getty Images/ChesiireCat)

The Centers for Medicare & Medicaid Services (CMS) failed to meet a deadline required under the Medicare Access and CHIP Reauthorization Act (MACRA), according to a recently released report (PDF) from the Government Accountability Office (GAO).

CMS was supposed to implement a process for reviewing prior authorizations for chiropractic services billed to Medicare by Jan. 1, 2017; however, it has still not established that process, the watchdog agency says.

Chiropractic services have a disproportionately high rate of improper payments, the report explains. Of the $700 billion CMS spent on healthcare for Medicare beneficiaries in fiscal year 2016, only $540 million—less than 1%—went toward chiropractic services. However, the improper payment rate that year was 46%, compared to 9.7% overall (PDF). CMS attributed most improper payments to insufficient or incorrect documentation.

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Improper chiropractic payments have decreased over the last several years but still accounted for 41.7% of payments to chiropractors in 2017.

RELATED: Chiropractors blast UnitedHealthcare’s ‘fundamentally flawed’ policy shift on spinal manipulation

Under MACRA, the Department of Health and Human Services (HHS) needed to require prior authorization for certain chiropractic services and providers. It also required HHS and CMS to develop materials to train chiropractors how to complete a prior authorization request properly.

CMS developed the training materials, which include three articles and a YouTube video. However, it did not develop a process for reviewing the mandated prior authorizations.

CMS says it will begin working on the prior authorization process with a notice of proposed rulemaking this December, according to GAO.

GAO reported HHS did not have any comments about their findings.

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