CMS published, through The Medicare Learning Network® (MLN), a fact sheet dispelling some myths about coverage for chiropractic services. Below is a summary of key points in the fact sheet published in October 2011.
Misinformation #1: There is a 12 visit cap or limit for chiropractic services.
Correction: There are no caps/limits in Medicare for covered chiropractic for properly licensed and enrolled chiropractors. Some Medicare carriers may require a review of documentation at a certain number of services, but a cap/limit is not allowed.
Misinformation #2: If you are a non-participating (non-par) provider, you do not have to worry about billing Medicare.
Correction: All Medicare part B covered services must be billed to Medicare by the provider or the provider could face penalties. There is an exception to the “Mandatory Claim Submission Rule” when a beneficiary has signed a valid Advance Beneficiary Notice of Noncoverage (ABN) with Option #2 selected.
Misinformation #3: If you are a non-par provider, you will never be audited nor have claims reviewed, etc.
Correction: Any claim submitted to Medicare may be audited/reviewed. The participation status of a provider does not affect the possibility of claim audit.
Misinformation #4: You can opt out of Medicare
Correction: Doctors of Chiropractic (DC) may not opt out of Medicare. It is important to note that opting out and non-participating are not the same things. See Chapter 15, Section 40; Definition of Physician/Practitioner for more information on “opt out”.
Misinformation #5: You should get an Advance Beneficiary Notification (ABN) signed once for each patient and it will apply to all services, all visits.
Correction: The decision to deliver an ABN to a patient must be based on the expectation that Medicare will not cover a particular service because it is deemed not medically necessary in this instance. Medicare beneficiaries may elect to pay for the services and the provider does not need to file a claim, require the provider to file a claim but agree to be responsible for payment if the claim is denied, or they may elect not to receive the services.
Misinformation #6: Maintenance Care is not a covered service under Medicare.
Correction: Only acute and chronic spinal manipulation are considered active care and reimbursable by Medicare. Maintenance care is not considered medically reasonable and necessary, therefore, not reimbursable by Medicare.
Misinformation #7: Non-par providers do not have the same documentation requirements as par providers.
Correction: Chiropractic care has documentation requirements. The participating status of the provider is irrelevant to the documentation requirements. Specific details regarding documentation requirements are in the Medicare Benefit Policy Manual (Chapter 15, Sections 30.5 and 240) at http://www.cms.gov/manuals/downloads/bp102c15.pdf on the CMS website.
Misinformation #8: DME ordered by a DC will be reimbursed by CMS.
Correction: A chiropractor may act as supplier of durable medical equipment (DME) if they have a valid supplier number assigned by the National Supplier Clearinghouse, but a chiropractor will not be reimbursed if they order DME.
The complete fact sheet can be downloaded here.
For further information about Chiropractic issues and Medicare, contact your Medicare carrier. Contact information can be found at http://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/MedicareProviderSupEnroll/downloads//contact_list.pdf.
If you need assistance with Medicare provider enrollment for your chiropractic clinic, nCred can help. We’ve helped many chiropractors enroll their practice entity and themselves along with other practitioners in the Medicare program. nCred has assisted many Chiropractic clinics enroll their Integrated Health clinics that include Physicians and mid-level providers; and in some cases DME services.
Give nCred a call today at 423.443.4525 to discuss how our services can meet your practice needs.
Additional reading related to Chiropractic services and Medicare:
http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/bp102c15.pdf
