As with all things insurance, the one constant is change.  Obviously, the feds are no different.  Here are four 2019 Chiropractic Medicare updates you must know now (as they are effective January 2019).

Medicare Deductible

We’ll ease into this with the simple fact that CMS has announced that the deductible has increased slightly for Medicare beneficiaries in Part B, which covers the services you provide as chiropractors (see link below for fact sheet).

The 2019 Medicare deductible is $185.

Medicare Participating Status Change Period

Each year, Medicare allows you to change your participation status as a chiropractic provider during the last six weeks of the calendar year.

There’s lots of confusion in these terms as well as plenty of misinformation regarding whether or not chiropractors can opt out of Medicare.

We’ll keep this part of the 2019 Chiropractic Medicare updates very short and cut to the chase:

  • Chiropractors have two options in Medicare – they are either Participating (Par) providers or Non-Participating (Non-Par) providers.
  • Both of these options are subject to the same basic rules in Medicare, although the reimbursement scenario is slightly different. PAR providers bill Medicare and receive their reimbursements directly from Medicare. Non-PAR providers may collect from the patient up front, bill Medicare and their patients receive the reimbursements from Medicare.  Consequently, non-Par providers have a slightly lower reimbursement rate.
  • At this time, chiropractors do not have the option of opting out of Medicare, as other providers do.

For additional clarification on all three items, see the article here: Can Chiropractors Get Out of Medicare

Medicare Documentation Requirements Relaxed

In 2019, Medicare has also revised and relaxed the documentation requirements for E/M codes (a little bit).

While chiropractors currently are not reimbursed for E/M codes in Medicare, this change will likely have broad ranging impact of private payer documentation requirements, as their guidelines for proper E/M coding and documentation is based on Medicare guidelines.

See the article here for details: How New Medicare Documentation Changes Will Affect Your Chiropractic Practice

Medicare Advantage (Finally & Possibly) an Advantage

Since the inception of Medicare replacement plans such as Medicare Advantage, the promise has been that these plans could and would deliver additional benefits to Medicare beneficiaries.

Unfortunately, this hasn’t quite been the case with most of these replacement plans as the general reporting from patients and providers was that the plan benefits were actually lower or worse than being on Medicare itself.

In terms of 2019 Chiropractic Medicare updates, there is good news on the horizon in (some) marketplaces where Medicare Advantage plans are offering benefits that equal or exceed standard Medicare plans.  For example, Washington & Oregon Medicare Advantage plans through Regence BCBS (in select counties) are offering $20 co-pays with 18 visits per calendar year.  With a lower deductible than many private plans (where we now see deductibles routinely $5000 and up) and stingy visit limits (of 6 or 12 visits per year), there is a distinct possibility that Medicare Advantage plans can actually be…an advantage.

The onslaught of Baby Boomers entering Medicare and the Medicare Advantage marketplace still continues, so it makes sense that the payers are getting more competitive in their enrollment strategies.  So for example, in Washington State one Medicare Advantage carrier (Premera BCBS) recently took on a major employer plan (Soundpath Health) that allowed them to enroll over 25,000 Medicare Advantage patients and expand operations into four additional counties.

Similar moves are happening all over the country as payers are trying to be more competitive with the 2019 Chiropractic Medicare marketplace. Unfortunately, this is not the case in every market so be sure to look into the changes coming to your area.

If you want to dive deeper on these Medicare change – and more private payer insurance changes as well –get the RECORDING of our Chiropractic Insurance Billing, Coding & Documentation MASTERY seminars so you don’t miss out!