The Nevada Division of Insurance deliberated on the issue of chiropractic billing Jan. 18 at a public meeting.
At the meeting, the division addressed chiropractic billing and whether a chiropractor physician who is performing the same services as a medical physician, or M.D., can receive the same fee for service from insurance payors. Dr. Jason Jaeger, a local chiropractor physician and member of the Nevada Chiropractic Council, presented the case for a more equitable insurance reimbursement policy for chiropractors.
Jaeger’s presentation to the DOI was well-received. There was no resistance to the proposals during the meeting. In fact, the only question posed during the meeting concerned the logistics of implementing such a rule. The DOI is expected to further deliberate on and investigate the issue and present the final decision in a few weeks.
According to section 2706 of the Affordable Care Act, an insurance provider or a health plan is prohibited against discriminating against providers who are acting within the scope of their licenses. Therefore, for a similar or same service performed, an insurance plan should not discriminate between a chiropractor or an orthopedic physician with respect to reimbursement.
In the Center for Medicare and Medicaid Services’ regulation section 70, the definition of “physician” includes chiropractors. Seventeen states have implemented statutory language to make their own laws consistent with the ACA and Center for Medicare and Medicaid Services specifications. However, Nevada is yet to implement its statutory language to include these non-discriminatory provisions.
When government and third-party payors impose limits on the number of patient visits, the percentage of reimbursement per visit etc., and do so only for chiropractors and not their medical doctor counterparts, they are essentially limiting the access of patients to their care providers. In addition, such discrimination against chiropractic care explicitly violates Nevada Revised Statutes 689A.049 and 689B.039. Both these statutes allow appropriately licensed chiropractors to be reimbursed in parity with other physicians for the care they provide.
This discriminations is especially stark when one takes a closer look at the billing codes. A number of billing codes are exactly the same between the 2014 ChiroCode Desk Book for chiropractic billing and the 2015 Current Procedural Coding Expert book for allopathic physicians. Billing codes 99202, 99203, 99204 and 99205 are described identically in these coding manuals. However, insurance companies will reimburse at different rates for the same billing code depending upon whether the claim has been submitted by an M.D. versus a chiropractor.
The two billing manuals are rife with similar examples of shared billing codes between chiropractors and M.D.s. However, insurance companies have a history of reimbursing the two types of claims disparately.
In light of the growing opioid pandemic, eminent voices in the medical community, including the Center for Disease Control and the U.S. Surgeon General agree the safe and effective treatment of pain is the first step in stemming the tide of new addictions. This sentiment was echoed during Gov. Brian Sandoval’s Nevada Opioid Summit where chiropractic care was presented as the foremost non-opioid treatment for pain.
Nevada lags far behind its neighbors (California, Oregon and Arizona) in the ratio of chiropractors to potential patients with only 626 active chiropractic licenses statewide as of this month. With a population of 2.4 million people, the resulting ratio is more than 4,500 people per chiropractor as compared to California (1,293 people per chiropractor), Arizona (3,022 people per chiropractor) and Oregon (2,527 people per chiropractor). Put simply, the state needs to attract more chiropractors. No parity reimbursement will a significant draw for these physicians.
The expected DOI decision will likely give chiropractors greater negotiation power against insurance companies as they will likely form interest groups as a hedge against expected private payor responses (paneling, closed networks, etc.). This decision also may impact the corporate practice of medicine laws in Nevada and obviate the need for many M.D.-D.C. practices.
Malvika Rawal, Ph.D., J.D. is a law clerk at Ideal Business Partners.
