Here we are again, in that wonderful time of the year, where the BIG question about Medicare starts to light up my inbox.  Yes, every November, I get hundreds of emails all asking the same questions with slight variations.

Unfortunately, there’s no right or wrong answer.  Maybe not even a good one – after all, it IS Medicare.  On the positive side, no matter what your dilemma, it’s likely not as painful as a choice as the fella in the above video (if you haven’t watched, click if you have a sense of humor.  I have no idea what they are saying, but no translation is needed 🙂

Back to the question — so what’s the dilemma?

Can Chiropractors Opt Out of Medicare?

The short answer is NO!

Since the online community affords a slight measure of anonymity, I realize that this response will bring in yet another flurry of emails about why your situation may be different. This can be loosely translated to: why you feel justified in your actions, despite the fact that you are breaking the rules.

Quite frankly, since it’s your hide and not mine, you can think whatever you want.

But here in the land of harsh reality, allow me to give you the straight dope, taken directly from one of Medicare’s bulletins:

“Opting out of Medicare is not an option for Doctors of Chiropractic. Note that opting out and being non-participating are not the same things. Chiropractors may decide to be participating or non-participating with regard to Medicare, but they may not opt out.”  MedLearn Matters SE0479

(Link to original article included, for those of you who purport to be Sherlock Homes and do your own investigating)

Bad Variations of the Medicare Opt Out

Some chiropractors take a creative approach to the fact that they can’t opt out of Medicare.  Unfortunately, these are about as good of a solution as the comb over is for the balding man and, when pressed, they fool about as many people.

  • Conscientious Medicare Objector – you can refuse on the grounds that it’s unconstitutional to be forced to play in the Medicare game. This argument runs along the same lines as your requirement to file taxes.  See where that got Wesley Snipes.
  • Don’t Ask, Don’t Tell – I have met multiple DCs at my seminars who claim that they just charge their patients cash and don’t submit anything to Medicare.  They not-so-brilliantly surmise that as long as they don’t tell the patient or Mr. Medicare, no foul will be declared.  That is, until a patient wants a reimbursement or wonders why their fee is higher than their brother Al’s who also sees a chiropractor who actually bills Medicare.  When that trouble brews, Dr. Smartypants contacted this troublesome beverage.
  • I Just Tell Patients I Don’t Do Medicare:  This is similar to bad option #2 with a good dose of truthfulness thrown in.  These docs are straight up with their patients and don’t try to be evasive about the fact that they won’t bill Medicare for anything.  Most of these docs have a good plan in place for explaining why.  What they often lack training in the proper requirements which state: you can’t opt out of Medicare!

So, If Chiropractors Cannot Opt Out of Medicare, What Can We Do…

Yes, for those of us, who labor under the delusion that this is at least occasionally a free country, you want choices – right?

Well, obviously, as stated above, opting out of Medicare is not an option for chiropractors.

You DO have one choice, however, in how you play the Medicare role of a provider and it comes the last 6 weeks of every year.

It is this: you are able to change your status from Par to Non-Par.  You can fill out the paperwork to change your par status and continue to play same rules, albeit with a different reimbursement process.

The Par vs Non Par Debate or Non-Debate

First, let me clarify that Par or Non-Par status is simply a payment issue.  Any talk you have heard in connection with par status and audit-protection is theory at best and dangerous rumors at the worst.

  • Fact 1: Par providers are paid 5% more than Non-Par.
  • Fact 2: Non-Par providers can collect upfront from their patients if they do not accept assignment.
  • Fact 3:  NEITHER situation provides any guarantee or protection from audits!  Here’s why: you are subject to the same rules in both camps.

Obviously, they each have advantages and disadvantages – and you only can switch your status once per year, so choose wisely!

The Final Word

Whether or Not You Think You are In Medicare, You are in Medicare. Remember that lovely little thing called the NPI that was instituted a few years back?  With this number, each and every payer can (and does) track your every move – including Medicare.  So, even if you are blatantly trying to ignore Medicare by “staying under the radar” and providing all your services in exchange for chickens, lawn care or for free out of the kindness of your heart, IF you have provided a chiropractic adjustment to a Medicare beneficiary you are in the Medicare system.

The fact that you didn’t complete a provider application, that you don’t submit any claims to Medicare or that you can’t find anything from Medicare that indicates you are a provider, you are still subject to Medicare rules and regulations. Even if you got a letter stating that you lost your billing privileges, you are in Medicare (you just can’t legitimately get paid).

Practically speaking, you have provided services to a Medicare beneficiary via a “private contract” (as defined in the Medicare Benefit Policy Manual, Ch. 15, Section 40.7).  Unfortunately, as a chiropractor you are not allowed to have a private contract with Medicare patients because only those who can opt out can legally establish a private contract

Therefore, you are in Medicare, but not playing by Medicare’s rules.  Likely, you are in trouble as well and you should fix this situation immediately, as Medicare penalties are not for the faint hearted.

What to Do If You’ve Been Operating Slightly Ignorant of These Rules

For those of you who have been operating inefficiently, illegally or somewhere in between and have been brought to light by this post, I don’t need to hear your confession or defense of why you have been in the dark about this.

Instead, it may be time to take concrete steps towards more closely evaluating your billing department (whether in-house or outsourced), as they should know and/or catch some of this for you.  For some of you, it may be time to shop for a new staff member or billing service – as your present one has allowed you to jeopardize a lot by operating this way. For others, it may be time to attend a seminar and learn what you are missing (in the positive and in negative areas like this).

And for most of you, I can guarantee that even if you are doing THIS correctly, there’s other things that you can do to improve — which is yet another reason to sign up for one of our upcoming chiropractic seminars (which always cover much more than Medicare)