CMS creates barrier to Medicare demo project

The Centers for Medicare and Medicaid Services (CMS) has put a roadblock to the success of the Medicare demonstration project, according to Garrett Cuneo, executive vice president of the American Chiropractic Association.

In his weekly report to members, Cuneo says that CMS is requiring chiropractors who participate in the demo project to comply with the “incident to” provision concerning physical therapy. The ACA had previously understood that a doctor could participate in the project and permit the staff to administer therapy and bill the therapy as uncovered services. CMS is now stating that this is not permissible.

Thomas R. Daly, an attorney with Odin, Feldman & Pittleman, P.C., the law firm that represents the ACA, explained the “incident to” provision. He said, “The recently adopted ‘incident to’ regulations will require all office staff providing and billing Medicare for ‘incident to’ therapy services to have received training from a program recognized by the AMA [American Medical Association] or APTA [American Physical Therapy Association].”

Daly explained that this requirement only applies to staff; the doctor may personally provide the therapy service and bill Medicare.

Since most chiropractic office staff do not have such training yet provide the bulk of therapy services, the ACA has objected to the application of these new regulations to the chiropractic Medicare demonstration project.

Daly said that the secretary of Health and Human Services has the authority under the demonstration statute to waive the application of these regulations.

The ACA is pursuing a waiver to the “incident to” provision.

Sources: American Chiropractic Association, www.amerchiro.org; Thomas R. Daly, Esq., Odin, Feldman & Pittleman, P.C., www.ofplaw.com

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