Can Chiropractors Opt Out of Medicare?

With the election looming and the victory of an undesirable political candidate within the realm of probability (regardless of which side of the fence you are on), some chiropractors are looking to exit the madness called Medicare.  Even during non-election years, frustrated chiropractors are seeking ways to reduce their Medicare woes and increase the chances of some profits beyond the paltry payments offered by the federal giant.

And yet, the chiropractor who is serious about departing from Medicare AND simultaneously serious about staying compliant will find themselves with a bit of a dilemma on their hands.  Generally, three questions are asked in the endeavor to solve this problem:

  1.  Can chiropractors legally opt out of Medicare?
  2. Can chiropractors legally bypass or ignore Medicare and just go cash?
  3. If the answer to #1 and #2 is no, what else can chiropractors do to limit Medicare losses?

Here’s the Bad News — Part 1

Each year, I publish a similar article trying to state this fact as clearly as possible and each year, I get a flurry of emails arguing the point, but the fact remains pretty simple:

To date, Chiropractors do NOT have the ability to opt-out of Medicare.

Phrase it any way you want: you cannot you cannot kick their policies to the curb; show their laws your size 10’s or in any meaningful manner, tell Medicare to get their rules out of your life. This remains the law of our land in the chiropractic profession primarily because…um…Medicare says so.

I know that you who are prone to argue don’t like to read much from Medicare (few do), but it is spelled out quite clearly in the infamous Medicare Benefit Policy Manual  (underlining and bold text is mine):

40.4 – Definition of Physician/Practitioner (Rev. 62, Issued: 12-22-06, Effective: 11-13-06, Implementation: 04-02-07) For purposes of this provision, the term “physician” is limited to doctors of medicine; doctors of osteopathy; doctors of dental surgery or of dental medicine; doctors of podiatric medicine; and doctors of optometry who are legally authorized to practice dentistry, podiatry, optometry, medicine, or surgery by the State in which such function or action is performed; no other physicians may opt out. Also, for purposes of this provision, the term “practitioner” means any of the following to the extent that they are legally authorized to practice by the State and otherwise meet Medicare requirements: Physician assistant; Nurse practitioner; Clinical nurse specialist; Certified registered nurse anesthetist; Certified nurse midwife; Clinical psychologist; Clinical social worker; Registered dietitian; or Nutrition Professional. 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.

So, unfortunately, that takes care of question #1.  The answer is NO.

Here’s the Bad News — Part 2 (Or Why You Can’t Dodge the Medicare Dictatorship)

While a bold-faced “no” is enough to stop most folks in their tracks, there are some who immediately begin looking for a loophole or a way around the obvious.  These tenacious chiropractors may have missed their calling in the fields of tax or law, but in terms of chiropractic, this is a tough case to win.

Here’s why:

If we, as chiropractors, are unable to legally opt-out of Medicare, then we are legally stuck and subject to the rules of the Medicare program.

But to be fair to our bending the rules brethren, there is one way that a a number of chiropractors each and every year ignore ALL of the rules of Medicare. Unfortunately, it involves not just not adhering to the laws of Medicare; it pretty much involves not adhering to life itself.  In other words, you can always get out of Medicare…when you are dead.

Since this is quite the extreme example, amny will ask if there are exceptions made for practices of a certain size, volume, type — etc.  Unfortunately, the answer is “NO” again.  The only legal, compliant way around Medicare as a chiropractor and for which an exception has been granted is to the deceased.

 What If I “Think” I’m Out (Because I Never Got In)  & Other Bad Conclusions

Each year, I usually  get a few emails or seminar attendees explain to me that do not need to get “out” of Medicare because they have never gotten “in.”  This argument fails for the same reason gravity succeeds.  Just because you didn’t study gravity (or fill out the required Medicare paperwork) doesn’t mean it doesn’t apply to you.  Just as gravity applies to every human on the planet, whether they are aware of it, whether they agree with it or have studied it or not; the rules of Medicare applies to every chiropractor.

Over the years, I’ve had a number of DC’s come up to me at my chiropractic seminars and whisper that they have discovered “the secret” method to getting out of Medicare.  On two occasions, I even had two chiropractors furnish a letter as “proof” that they had wiggled their way out of the web — or so they thought.

What these practitioners had produced was a letter stating that they lost their billing privileges in Medicare.  In other words, because of years of inactivity, their Medicare enrollment had been removed and essentially they lost the right to seek reimbursement for themselves or their patients for their chiropractic services.

While this sounds like they are out of the system, note one subtle difference:  the letter informs them that their loss of billing privileges does NOT negate their responsibility to follow Medicare rules and regulations — it only negates their ability to get paid for these services!  In other words, these chiropractors are STILL in the Medicare system, they STILL have to abide by Medicare’s rules AND (worse of all) they cannot legally collect for any services that are eligible for reimbursement by Medicare (the chiropractic adjustment).

In the end, their discovery is actually a dead end.  Losing your billing privileges is not a win; it’s even more restricting than if you were still “in” Medicare (which you have been all along) because at least those who are “in” the system can get paid!

The Sort-of Good News About Medicare…NOW!

Once we come to accept the fact that we chiropractors are legitimately stuck in Medicare, we can begin to change the way we play within the system.  Obviously, this is not the same as getting out.  But it is important.

Here are the facts:

  • Each year, during the last 6 weeks of the calendar year, you have an option of changing your PAR status in Medicare.
  • If you miss this 6 week window, you are stuck with the same status for another year
  • Changing your status does not change the rules, but it does change the reimbursements

The Benefits of Going NON-PAR in Medicare For Chiropractors

As stated above, going NON-PAR does not allow you to opt out of Medicare, not does it allow you to ignore the rules.

What it can do is reduce administrative tasks by allowing you to collect up front from your patients without waiting for Medicare.

It also gives you a slight advantage in the case of Medicare reviews, audits and even “normal” things like moving your office because you continue to collect up front from Medicare and you avoid the sting of someone holding onto your money while the administrative or audit wheel turns very slowly.

But that’s it.  There’s no fool proof solution.  For more info on going NON-PAR, see our previous post, entitled “Fed Up With Medicare: The 6 Weeks Chiropractors Can Change” for more details.


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