Fed Up With Chiropractic in Medicare? The 6 Weeks Chiropractors CAN Change

Yes, it’s official.  If you have been getting progressively more frustrated with Medicare this year, this is your one chance to make a small change that may help ease some of the pain. every November, I get hundreds of emails all asking the same questions with slight variations.

As you may or may not realize, during the last six weeks of each calendar year you have your one and only chance to change your provider status in Medicare.

That is – you can switch from PAR to Non-PAR.

What’s The Big Difference Between Par vs Non Par?

Essentially, Par or Non-Par status is mainly a reimbursement issue.  In other words, the rules are the same either way in terms of your chiropractic compliance requirements.  Here are the differences, plain and simple:

  • Par providers are paid 5% more than Non-Par.
  • Non-Par providers can collect upfront from their patients if they do not accept assignment.
  • NEITHER situation provides any guarantee or protection from audits!  Obviously, they each have advantages and disadvantages – and you only can switch your status once per year, so choose wisely!

Audit Advantages?

I get many questions asking whether there is any advantage to par status regarding Medicare audits?  In terms of audit prevention, the answer is definitely NO.  Medicare is an equal opportunity auditor and will audit either category of chiropractors at its own discretion.

On the other hand, in terms of audit protection, there may be a slight advantage to being Non-Par.

Here’s why: if Medicare audits you, one of their tools they can use is called the “pre-payment” review.  If you are unfortunate enough to have this happen, it basically means that Medicare must audit each and every SOAP note in order to approve reimbursement for your chiropractic services.

If that sounds brutal, it is – in several ways.  As a chiropractic billing, documentation and coding “expert” who has helped more than his fair share of chiropractors and attorneys representing chiropractors faced with Medicare audits, here’s the grim reality of the pre-payment review process from my admittedly biased perspective.

1)    Most of the chiropractors on pre-payment review take a year or more to get out of the review process (in other words, it takes them 1 yr+ to produce a note that satisfies Medicare to the degree that they call off the audit dogs)

2)    In the meantime, pre-payment review means that Medicare pays $0 unless you have a satisfactory note.  Translation: pre-payment review is the ultimate cash-flow killer if you have a significant portion of your practice that is Medicare.

3)    Pre-Payment review frequently causes massive audit anxiety.  When someone looks at each and every note you take and generally frowns upon them as unsatisfactory, your demeanor begins to change. You begin to become paranoid that you are doing everything wrong.  You begin to become frustrated with “the system” and tired of playing “the game.” Some DC’s want to leave chiropractic all together.

4)    Your volume generally suffers.  Given #1-3, as you may imagine, there are many factors that mess with your head and in turn, affect your volume for the worse.

So, being Non-Par doesn’t change all of that, but it does at least keep your cash flow going. It also serves as a subtle reminder that if PATIENTS are paying for your services, then they value what you are doing – regardless of what some Medicare auditor may say about the necessity of your chiropractic care or the quality of your chiropractic documentation.

And in the big picture, these two reminders may play a big role in saving your sanity

So, How Do I Go Non-Par And Other Questions

To change your par status, you must contact your local Medicare carrier prior to December 31 (and after approximately November 15) and follow their instructions.

That’s it.

Although it is surprisingly simple, the rules are completely inflexible.  Miss this window and you are stuck in for another year. That’s it!

WONDERING WHAT ELSE TO DO?

If you’re on the fence about getting out because you don’t understand all the requirements that are coming your way, you are not alone!  Check out our FREE WEBINAR Making the Medicare MACRA Decision in 2018 for tips and strategies on how to make the best decision for your practice.

 

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