Are you Medicare compliant?

by Dava Stewart

Medicare may seem like a labyrinth of governmental hoops, red tape barriers, and walls of impenetrable bureaucracy. But, the fact is, if you see patients covered under Medicare and you want to get paid for your services, you have to be able to navigate that labyrinth efficiently, and without tripping. Your practice needs to be Medicare compliant.

The first step is to understand what being Medicare compliant means for chiropractors. One good place to start is with a booklet, which was published by the Centers for Medicare and Medicaid in October 2013, titled Chiropractic Services. This literature answers frequently asked questions regarding qualifications and payment requirements.

To get a more detailed look at Medicare requirements and regulations, you will want to delve into the Medicare Benefit Policy Manual, chapter 15, “Covered Medical and Other Health Services,” most recently revised on April 4, 2014.

One important thing to realize is that chiropractors do not have the option of opting-out of Medicare. The CMS specifically addresses this question on page 25, in section 40.4 of Chapter 15 in the manual. DCs can choose to be non-participants, but that is not the same thing as opting out, nor does it mean they are not required to bill Medicare. If you treat a patient who is covered by Medicare, you must bill Medicare. In addition, being a non-participant does not exempt you from being audited. The CMS details the differences between non-participation and participation in a document titled “Medicare Enrollment for Physicians, Non-Physician Practitioners, and Other Healthcare Service Providers.”

Participation or not aside, in all likelihood, you will be billing for Medicare for some services, and there is the possibility you will be audited for compliance. There are several points to keep in mind:

• You can only bill Medicare for covered services. The Medicare Benefit Policy Manual is very specific in stating, “Coverage extends only to treatment by means of manual manipulation of the spine to correct a subluxation provided such treatment is legal in the State where performed,” according to the Medicare Benefit Policy Manual, page 20, section 30.5.
• Maintenance therapy, x-rays, and many other services are not covered.
• A detailed treatment plan must exist.
• Visitation notes are crucial.

One of the best ways to make sure all paperwork is in order and will protect you in the case of an audit is to use a certified electronic health records (EHR) software system. Certification means that the system has been vetted and tested. Implementing the system throughout your practice and even hiring a third party to evaluate your audit-preparedness may provide further protection.