KMC University on Medicare

No “opting out”

Patients and doctors alike prefer to have choices. But when it comes to Medicare, chiropractors have very little wiggle room.

Unlike medical doctors, chiropractors don’t have the choice to “opt out” of Medicare. You can be participating (“par”) or non-participating (“non-par”), but either way, you’re legally responsible for billing Medicare for medically necessary adjustments and providing the required documentation.

Unfair? Maybe. Non-negotiable? Absolutely.

No charging cash without billing

At seminars and state association meetings, we’ve met DCs who try a work-around by telling patients they “don’t do” chiropractic Medicare and just charge cash without billing. This makes us incredibly nervous just to hear about—and if you’re doing it, you should be nervous, too. You see, it all comes down to this: to treat a Medicare beneficiary, you must be equipped to bill Medicare if they ask you to, even for statutorily excluded services. That means you have an active registration with Medicare.

Many doctors tell us they “just want out and are afraid of Medicare. But we say, following the rules isn’t difficult—if you know what they are and how to navigate the currents, like we do here at KMC University.

Here are some ways chiropractic professionals can get into hot water with Medicare:

• Financial Inducements: Whether it’s a coupon, a promotion, free X-rays or free exams, or undocumented but well-intentioned “financial hardship arrangements” for patients in need, it’s illegal and it’s high-risk. Simply put? Stop it. We can show you a better way.

• Maintenance vs Acute or Chronic Care: Medicare pays for what they define as “medically necessary” chiropractic adjustments. They expect doctors to clarify when treatment is for an active episode, which means treatment that has a clear beginning, middle, and end. Once care becomes for the wellness of the patient, or supportive rather than corrective, it’s considered maintenance as far as Medicare is concerned—and it’s no longer covered. Of course, your patient can have that treatment and pay directly. That’s what the Advance Beneficiary Notice (ABN) is for. Confusion about these definitions causes more chiropractic Medicare audits and subsequent recoupments than any other issue in Medicare. We can help you do it correctly and explain it easily to your patients.

Bring us your questions

Although Medicare seems simple because we only have three codes to deal with, it has the potential to be your biggest headache. If you’re like most DCs and chiropractic team members, you’ve got questions when it comes to Medicare. Whether they’re about what to charge, how to bill, Medicare’s documentation rules, or even how to enroll, KMC University has the answers—far more answers than we can fit on this single page. It’s worth your time to explore these pages to find out more about how we can help keep you out of seriously hot water. Your peace of mind—and the health of your practice—depend on it.

Call (855) 832-6562 now or click to schedule a 15-minute Solution consultation at your convenience.

Solution Consultation

Want instant help? Chat with us now by clicking the button in the lower right corner of your screen.