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DCs Must Enroll in Medicare to See Medicare Patients

Rhonda Hodge MCS-P
in Medicare
By Rhonda Hodge MCS-P

Make no assumptions about Medicare

New graduates begin their chiropractic career and, for whatever reason, the mere mention of the word “Medicare” can cause a heart rate to quicken. The fear of Medicare is causing some new providers to assume they can see Medicare patients and avoid billing on behalf of the patient. Truth is, doing so is FAR worse than anything else.

Medicare of today is not the same Medicare we knew of years ago. Horror stories one may have heard are causing unnecessary worry. Medicare guidelines are among the clearest and most well defined of any third-party payer, and with their goal of publishing this information, the result has been a decrease in errors on billing, enrollment and many other areas.

Chiropractors may not opt out of Medicare

However, misconceptions and confusion still prevail about a DC’s ability to see a Medicare patient, for either a covered or excluded service, without being enrolled. This is also known as “opting out” of Medicare. To “opt out” as Medicare defines it, a doctor can treat a Medicare beneficiary and, if opting out, then neither the doctor nor the beneficiary would bill Medicare. Chiropractors may not opt out of Medicare, even though other specialties can.

Some of the confusion may stem from the verbiage chosen in the guideline. Medicare doesn’t require all Chiropractors to enroll with Medicare. Your option to turn Medicare patients away, or to refer them elsewhere is still a valid choice. Medicare DOES state that as a Doctor of Chiropractic you cannot place your hands on a Medicare patient or deliver any treatment (covered or non-covered) without being actively enrolled with Medicare and have the ability to bill Medicare for the services rendered to a beneficiary. This is due to mandatory billing requirements.

Can you choose, if you want, to enroll with Medicare or not? Yes, absolutely. But if you choose NOT TO ENROLL, then you cannot touch a Medicare patient. This is one of the clearest guidelines in Medicare, and Chiropractors are only one of the three provider types that this guideline applies to. Along with this, you must remain actively enrolled by doing periodic revalidations.

Note that opting out and being non-participating are not the same thing. Chiropractors may decide to be participating or nonparticipating in Medicare, but that means they are enrolled and able to treat Medicare patients. If your desire is to remain more of a “cash-based” practice, collecting most of your money across the front counter, you should choose the non-participating option. This means you’re enrolled, able to submit the bill for active treatment to Medicare, and to submit any other service as requested by the patient. However, your patient will pay you at the time of service, up to the Medicare limiting fee, and wait to be reimbursed for medically necessary services. Of course, both participating and non-participating providers collect 100% of their actual fee for all services excluded from Medicare, such as evaluations, x-rays, and therapies.

Avoid unnecessary risks to your practice

If you find yourself in a sphincter tightening situation right now because you do not have a valid Medicare number, and are seeing Medicare patients for “cash” adjustments, let’s get that addressed immediately. It’s not compliant, and it’s placing your practice and you at unnecessary risk. Take steps to clean it up now. We’re experts at this, and would love to assist you with making these corrections, documenting compliantly and giving you peace of mind.