The following has been adapted from “Medicare Made Simple” as presented by Susan A. McClelland, BS, CCA, FICC (h.c.) 
 
1. Myth: There is a 12-visit cap on chiropractic services.

    Fact: There are NO caps in Medicare for chiropractic at this time. However, there may be screens or intervals where the carrier will require a review of the provider’s documentation as a condition for reimbursing further care.

2. Myth: A Doctor of Chiropractic can “opt out” of Medicare.

    Fact: Doctors of Chiropractic can NOT opt out of Medicare. Please note: Choosing to be a non-participating provider is NOT the same as opting out.

3. Myth: A Doctor of Chiropractic may treat Medicare beneficiaries without being registered.

    Fact: Doctors of Chiropractic may treat Medicare beneficiaries without being registered; HOWEVER, if a Doctor of Chiropractic provides a covered service (i.e., spinal manipulation) to a Medicare beneficiary, the Doctor of Chiropractic would then be required to submit a claim to Medicare — and the provider must be registered to submit a claim.

4. Myth: A non-participating provider (non-par) does not have to bill Medicare. 

    Fact: Being non-par does NOT exempt the provider from having to bill Medicare.

5. Myth: A non-par provider will never be audited or have a claim reviewed.

    Fact: Any Medicare claim submitted can be audited/reviewed, regardless of provider status. The participation status of the provider does not affect the probability of this occurring.

6.   Myth: Non-par providers do not have the same documentation requirements as par providers.

      Fact: Medicare has documentation requirements for chiropractic care, regardless of provider participation status.

7.   Myth: Maintenance care is not a covered service under Medicare.

      Fact: The service of

spinal manipulation is a covered service under Medicare, regardless of the beneficiary’s phase of care (acute, chronic, or maintenance); however, maintenance care, although “covered” is not “reimbursable,” as it is considered by Medicare to be not reasonable and necessary. Acute, chronic, and maintenance adjustments are all “covered,” but only acute and chronic services are considered active care and, therefore, may be reimbursed. A provider must submit a claim for all covered services, regardless of whether they are reimbursable. This includes maintenance care.

8.   Myth: An Advance Beneficiary Notice (ABN) should be signed once for each beneficiary, and then it will apply to all services and all visits.

      Fact: Blanket and/or generic ABNs are forbidden. The decision to deliver an ABN for covered services must be based on a genuine expectation that Medicare will deny payment for the service due to it being not reasonable and necessary. A Doctor of Chiropractic should use an ABN for “maintenance care” spinal adjustments.

Please note: there is a new ABN available, which will be mandatory March 1, 2009. The new form and its instructions can be found at www.cms.hhs.gov/BNI/02_ABNGABNL.asp#TopOfPage.  

9.   Myth: Medicare has unreasonable documentation requirements.

      Fact: Medicare has specific documentation requirements, but nothing extraordinary. Regardless of whether a patient is a Medicare beneficiary, providers should exercise appropriate “standards of care” with thorough documentation of each beneficiary encounter.

10. Myth: Chiropractors can offer free x-rays to Medicare beneficiaries.

      Fact: “Inducements” are strictly forbidden for Medicare beneficiaries. Free examinations, x-rays and other valuable incentives could lead to accusations of fraud or abuse.