RISK MANAGEMENT MINUTE – Medicare & Chiropractors: Navigating the Complex Waters

ChiroFutures Malpractice Program
RISK MANAGEMENT MINUTE – Medicare & Chiropractors: Navigating the Complex Waters

Why it's Crucial to Understand Medicare Compliance and How ChiroFutures Can Assist

When it comes to Medicare, chiropractors often find themselves in a complicated web of rules and regulations. Recently, Dr. James found himself in a perplexing situation that many chiropractors might face. He reached out to the ChiroFutures Malpractice Program for guidance, and we'd like to share our response to ensure that other professionals can also benefit from this advice.

The Situation

Dr. James received a formal notice from CMS indicating that he had violated federal statutes about billing submission for Medicare patients. This revelation startled Dr. James, who believed that, as a wellness practitioner offering non-covered services, he was not bound by Medicare regulations.

The Common Misconception

There's a widely held belief among some chiropractors that if they offer wellness or maintenance care - services not typically covered by Medicare - they don't need to comply with Medicare rules. This is a grave misunderstanding. Chiropractors cannot simply opt out of Medicare. If a chiropractor sees a Medicare-eligible patient, they must adhere to Medicare rules, whether they bill for covered services or not.

The Facts

  1. Chiropractors have two choices: to be a Participating Provider (Par) or a Non-Participating Provider (Non-Par). Both require registration with Medicare.
  2. Treating Medicare patients without being registered (either Par or Non-Par) is a violation.
  3. Not providing a diagnosis or stating that a patient didn't present any symptoms doesn't exempt a chiropractor from these regulations.

Steps to Compliance

Dr. James was advised to take several crucial steps to ensure compliance:

1. Registration with Medicare: If he wishes to treat Medicare patients, Dr. James must register either as a Par or Non-Par.
2. Education: He should visit CMS.gov, focusing on the section for chiropractors, to familiarize himself with relevant rules and regulations.
3. Usage of ABN Forms: Understand the proper use of Advance Beneficiary Notice of Noncoverage (ABN) forms.
4. Patient Communication: Patients must be informed that maintenance or wellness care might not be covered, making them financially responsible.
5. Further Training: To avoid future complications, Dr. James was encouraged to attend a coding and documentation course focused on Medicare.

Why Having a Strong Malpractice Provider Matters

Situations like Dr. James' underscore the importance of having a trustworthy malpractice provider like ChiroFutures. Our expertise is not just in providing malpractice insurance but in offering critical guidance on compliance and best practices.

Remember, as with many regulatory matters, prevention is better than cure. Staying updated, seeking guidance, and ensuring compliance from the outset can save chiropractors from considerable distress and potential financial penalties down the line. Always have a partner like ChiroFutures to guide you through these intricate waters.

ChiroFutures Malpractice Program