Opting Out of Medicare: Clarification for Doctors of Chiropractic
Written by Editor   
Wednesday, April 30, 2014 01:47 PM

THE AMERICAN CHIROPRACTIC ASSOCIATION (ACA) receives inquiries from members on a regular basis regarding the rules and regulations surrounding opting out of Medicare. So, can a doctor of chiropractic (DC) opt out of Medicare? The short answer is, no. DCs may not currently “opt out” or privately contract with Medicare patients for the delivery of services outside of Medicare fee limitations and filing requirements. According to the Medicare Benefit Policy Manual (Chapter 15, Section 40.4), “the opt out law does not define ‘physician’ to include chiropractors; therefore, they may not opt out of Medicare and provide services under private contract.”

The requirements for opting out of Medicare are quite involved, and many doctors find them to be overwhelming. It’s not as simple as signing a form and becoming a cash practice. There are numerous regulations that must be followed and practices that must be upheld (e.g., fee restrictions). This is why less than 2 percent of all eligible providers choose to actually opt out of Medicare.

It is also important to note that opting out and being non-participating are not the same thing. DCs may decide to be participating or non-participating with regard to Medicare, but they may not opt out. Additionally, DCs can choose not to take Medicare patients at all, or to limit the number they take; that is their prerogative.

However, if they do choose to see and treat a Medicare beneficiary, they are obligated to bill Medicare for services provided, which requires a DC to be enrolled as either a participating or non-participating provider. Medicare has a “Mandatory Claims Submission” rule, which states that if a provider treats a Medicare beneficiary, he or she must be enrolled in Medicare and must submit claims to Medicare on behalf of the patient. This includes all providers — both participating and non-participating — and it includes both active (acute/chronic) and maintenance care.

In general, it only applies to covered services (spinal CMT); however, statutorily non-covered services must also be billed, if the patient requests that. Compliance with mandatory claim-filing requirements is monitored by the Centers for Medicare and Medicaid Services (CMS), and violations of the requirements may be subject to a civil monetary penalty of up to $2,000 for each violation, a 10-percent reduction of a physician’s payment once the physician is eventually brought back into compliance and/or Medicare program exclusion (which would mean the provider would not be able to treat Medicare patients at all).

Source:  http://mydigimag.rrd.com/display_article.php?id=1687739&id_issue=205525