It’s that oh so special time of year where chiropractors who have had their full of Medicare can choose to change their participating provider status.
Yes, in the last 6 weeks of every calendar year, chiropractors can elect to become Non-Par providers in Medicare and feel a slight taste of freedom.
Unfortunately, don’t get too excited about the event. Changing your provider status is NOT the same as opting out of Medicare. In fact, let me be absolutely 110% clear: as a chiropractor, you do NOT have the ability to opt-out of Medicare.
But you can change your participating provider status.
Why Chiropractors are Stuck in Medicare
To be totally accurate, there is one way chiropractors can legitimately ignore all Medicare rules. But it’s not for the faint of heart since, well, it does involve your death. So…since most folks who are eager to get out of Medicare are probably not irritated enough by Medicare by getting escorted via a permanent exit from this planet, we’ll go on to our other options.
As it stands, chiropractors do not possess the provider status in Medicare to opt-out. See below which is straight out of the 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.
Losing Billing Privileges Is NOT The Same As Opting Out of Medicare
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; its 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!
Making Medicare More Palatable
For the rest of you who understand that you cannot get out, there is a “Plan B” and some good news: you CAN make Medicare a bit more tolerable and with a few tweaks, perhaps even palatable!
1. Switch to NON-PAR Status. While this doesn’t eliminate your problems, it reduces the red tape by allowing you to collect up front from your patients without waiting for Medicare. It also gives you a slight advantage in case of an audit. See our previous post, entitled “Fed Up With Medicare: The 6 Weeks Chiropractors Can Change” for more details.
2. Minimize Medicare’s Impact: most of us can tolerate a small thorn in our side or a miniscule amount of risk. Simply put, the larger the percentage of your income or patient base, the greater the potential threat and sting of an audit will be. On the other hand, if you intentionally expand your non-Medicare business by increasing your non-Medicare patients and/or non-Medicare income, then proportionally speaking, the impact of Medicare is minimized. Regardless of your par-status, if Medicare irks you or keeps you up at night worrying, do yourself a favor and increase your non-Medicare business. You can get a jump start on this for next year with our latest webinar: How to Add Six Figures to Your Chiropractic Practice in 2016…Starting Now!
3. Learn How to Navigate Medicare…For REAL! Part of the challenge with Medicare is that they both wield a big stick (in terms of audits, penalties and even potential slammer time) AND a small checkbook (generally being the insurance payer who pays the least and offers the fewest benefits for participation). That said, we chiropractors actually increase our risk (by not understanding Medicare’s rules for chiropractic billing, coding and documentation) AND reduce the profitability of Medicare patients (through our lack of understanding of Medicare compliance, our misperceptions, our own procedures and our lack of any viable strategies to making Medicare more profitable). While Medicare may not be your most profitable patient base, there’s simply no reason to perennially permit Medicare to ruin your bottom line. The solution? Learn how to navigate the Medicare maze! My best recommendation: catch one of our upcoming chiropractic seminars where we dedicate time teaching you to do exactly that along with other chiropractic billing, coding and documentation strategies to help you work smarter, not harder.