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Proactive Aging with Chiropractic - We Can Help

Medicare
in Medicare
By Team KMCU

Proactive Aging with Chiropractic - We Can Help

According to AARP, there are currently 44 million Medicare beneficiaries (collectively). That is about 15% of the current U.S. population. This number is expected to rise to 79 million by the year 2030. That comes out to over 6.5 million incoming beneficiaries each year.

With a statistic like that, it would be safe to assume there are more people in the “geriatric” demographic than those that are not. So, as a Doctor of Chiropractic, how do we handle patients who are part of this large and ever growing demographic? There are several considerations to review, as well as, a commitment to increased and better communication with the patient about options.

The Realities of Cost

Although we never like to consider it, this is a reality for the beneficiary/patient. Is not uncommon to hear such phrases as “restricted income”, “singular income”, “limited income”, etc. Patients in these situations are often only interested in becoming pain free and not being seen for long term corrective treatment. It may be more feasible to consider a shorter treatment plan and incorporate low cost physical therapy in order to progress the patient further in a shorter amount of time. Keeping open lines of communication regarding any adjustments to the recommended treatment plan is beneficial to both the provider and the patient. Meaning, if the patient is feeling better and would like to come in less frequently, they certainly should feel comfortable stating that to the doctor. On the other hand, the doctor should also feel comfortable in stating to the patient how that will affect the progress they have made.

When cost becomes the reason a patient cannot get care, oftentimes one of two things may happen. Either the patient discontinues care, or an office may feel it is in the best interest of the patient to discount their fees. In this day of compliance, an office doing the latter of those two options could quite possibly land in an unfavorable situation.

If this is of particular concern in your office, take this opportunity to ask yourself the following questions:

  • Are you enrolled with Medicare?
  • Are you participating or non-participating?
  • Do you accept Medicare Advantage plans?
  • Do you also submit to secondary payers?
  • Are your current fees compliant?
  • Are your discounts compliant?
  • Is my office (provider and staff) well trained?

Each one of these questions can have a different effect on your fees and patient tenure.

Medicare Nuances

If enrolled with Medicare, it is important to know where to find your provider fee schedule. Once found, be sure to determine which one (either participating or non-participating) to abide by. If not actively participating in the PQRS/EHR program (currently MIPS), be certain to gain a full understanding of how to appropriately calculate your penalties.

In addition, be aware that Medicare Advantage plans do not always follow the Medicare fee schedule. Just because they say Medicare, does not mean they follow all original Medicare guidelines. “If” they participate and “how” they participate with Medicare can play a large role in the patient’s cost for services.

In most cases, original Medicare will submit claims automatically to any secondary payer if applicable. However, this does not happen with a Medicare Advantage plan.

Verify Insurance Benefits

We cannot stress enough how important it is to verify benefits for your patients that have insurance. The better your verification process, the better communication with your patients on how their insurance will help participate with their care and create a better overall patient experience. Insurance verification is the cornerstone of a great financial department. Because of that, it is just as important to properly convey to the beneficiaries how participation from their insurance is going to affect their cost. This may also directly affect the frequency of their visits.

As we know, in the chiropractic profession, Medicare only pays for active care CMT codes that are medically necessary. Because of this, many of the services that are beneficial to our patients are not covered. It is for this reason that offices often utilize a Discount Medical Plan Organization (DMPO) option for their patients. Having such a program available can be the difference between a patients opting to end their treatment protocol when they are out of pain or completing it, continuing care as maintenance, and seeing remarkable improvements in their overall health. Not sure where to begin when choosing a DMPO? We at KMC University recommend ChiroHealthUSA (CHUSA).

Because there are so many details in all the areas mentioned above, it is easy to understand why the patients can be confused or have questions about how these will affect them or their care. Communication is key! Take the time to explain to the aging patients all the ways that chiropractic can help them. Once they commit to a care plan, it is just as important to communicate what will happen along the way.

Set the Foundation

When your office sets policy in place that allows for better communication with the patients regarding issues such as the cost of their care, how their insurance will participate, their freedom to ask questions and communicate financial issues, as well as offer alternative options regarding finances, you and your staff can be confident in your ability to serve this demographic. This population sees larger increases every year than virtually all other patients. It is in your best interest to learn about serving the geriatric community. When these patients fully understand how their care will be handled, the overall cost of it, how their insurance will participate, and who to talk to when issues arise, they should feel more comfortable with your office and staff and will remain loyal patients.

New to the chiropractic profession? Set a good foundation for your office and start with this demographic of patients. Do your homework to understand the nuances of programs such as Medicare, Medicare Advantage, Medicare as a secondary policy, Medicaid or other federally funded programs. Implement the policies and procedures; train your staff to be compliant in these areas and you will be on your way to establishing a positive and lasting relationship with this demographic.

Need Help?

The KMC University Library is THE membership for you and your staff to learn the specific Medicare billing, coding, and documentation requirements for chiropractors. Join today and get the do-it-yourself chiropractic Medicare training you need.


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