Durable medical equipment and Medicare offer you an opportunity

Medicare continues to reimburse properly certified chiropractic, physical therapy, and other health care professional offices a strong net return.

Often as much as $1,000 on commonly used and needed durable medical equipment (DME) lumbar braces.

Not only is it possible, but hundreds of chiropractic offices are enjoying these levels of reimbursements. One category of brace for lumbar curvature (scoliosis) patients now gives about a $2,000 net return and is a lifesaver for the patient whose condition is “hopeless.” Most chiropractic offices will see about six or more of this type of patient per year.

The process of a chiropractic business becoming accredited and certified can cost up to $6,200 and take four to six months (or more). Most family practice chiropractic offices will net $40,000 to 80,000 per year just on existing patient flow. But by expanding their referral base, this could be much more. Those chiropractic offices that have become multidisciplinary often generate double or triple what chiropractic only offices can do.

As a consultant who has helped hundreds of chiropractic offices become accredited and certified with Medicare DME over the years, I hear the same questions over and over again from individuals seeking information about DME Medicare. You may have these same questions yourself.

Chiropractors are in

A common misconception is that chiropractors cannot become Medicare DME providers and that if a chiropractor becomes involved with DME Medicare, it is likely this involvement is both dangerous and fraudulent.

It is true that a diploma and a state license to practice chiropractic alone are not enough to be eligible to become a provider or supplier with DME Medicare. Medical physicians, osteopathic physicians, physician assistants, nurse practitioners, and physical therapists each have special “carve-out” exceptions and can become DME Medicare providers quickly with much less paperwork and costs than chiropractors. However, chiropractic offices can become accredited and thus be eligible to become DME suppliers.

Another thing some people wonder about is whether a chiropractic practice needs to obtain a medical doctor’s script for the DME supply (e.g., a lumbar brace) and, if so, how hard is it to get one. This is no myth—those offices that choose to become Medicare DME suppliers must obtain medical scripts the same as physical therapists have to obtain scripts to perform physical therapy in many states. Obtaining these scripts is surprisingly easy once you understand how to communicate with a medical physician’s office. This often enhances the chiropractor’s image and improves their relations within the local community of doctors.

Stark realities

One area where doctors of chiropractic start getting extremely nervous concerns the federal Stark laws against self-referral. And with good reason: You must make sure that you are not in violation or the penalties can be severe.

One way to clearly avoid the Stark law provisions is to have a referral for your durable medical equipment and supplies from an independent (not financially involved in any way) physician, nurse practitioner, or physician assistant.

There are numerous exemptions to the Stark laws if you do not get a “clean” script as stated in the preceding paragraph. It’s likely that most multidisciplinary offices will meet one or more than one of the exemptions. However, as the laws can have different effects by state, it is strongly recommended you consult with a professional health care attorney before entering this arena.

The Stark laws are strictly a liability statute and are federal only. The Stark laws restrict a physician’s referrals of Medicare and Medicaid patients for certain health care services if the physician has a financial relationship with the entity furnishing the health care services.
Each state may have its own laws in addition to the federal Stark laws.
If an arrangement falls within the scope of the Stark law, it will affect how you practice, where you can refer, and if you can own interests in or receive compensation from health care entities.
When a physician is referring patients to another physician in his or her practice for designated health services (DHS) that he or she does not ordinarily perform, this is called an exception for “in-office ancillary services.” This is much easier to be claimed by those working in a group practice. The physician must be the referring physician, be a member of the same group as the referring physician, or a person supervised by the physician. And the DHS must be provided in the same building and have appropriate billing by the group.
If a compensation arrangement is present, there are many exemptions, such as bona fide employment exemption, personal services exemption, and fair market value (FMV) exemption. Make sure the compensation arrangement is not directly related to the overall volume of referrals.

This can be a very complicated area of practice and it is recommended that each practice check and double check that services provided do not violate Stark laws, both federal and state. But you don’t have to be afraid of Stark laws if you have “done your homework” and are operating safely within the law—especially with respect to potential self-referral violations.

James C. Antos, DC, DABCO, is a consultant with Antos and Associates LLC, which provides DME certification consulting and DME product assistance. He can be contacted at 386-212-0007 or through antosdmebrace.com.