Can You Opt out of Medicare
The recent changes in health care have prompted talk of doctors choosing to opt out of the Medicare program. Is this a viable option for you as a chiropractor? Ignorance of the law is no excuse as they say.
You may have noticed a flurry of advertisements on television taunting patients to sign up with Medigap and Part C Medicare plans. The Part C Medicare plan is really not a Medicare plan, but a Medicare replacement plan. It is a way that a patient can opt out of Part B and buy a separate policy. The open enrollment period for a patient is from October 15 – December 7, 2013, in which a patient can change their status for 2014. This is a time where a patient may choose to opt out of Medicare Part B or opt back in. This right is not open to certain providers, though.
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Since January 2004, the Centers for Medicare and Medicaid Services (CMS) established that it is illegal for a chiropractor to opt out of Medicare. A medical doctor or doctor of osteopathy can opt out of Medicare. A chiropractor, physical therapist in independent practice and/or an occupational therapist in independent practice cannot opt out of Medicare and still see Medicare patients.
What does it mean to opt out of Medicare?
If an M.D. or D.O. opts out of Medicare, it means that, although they are treating a patient with Medicare insurance, they are not accepting Medicare’s payment for the services. As a chiropractor, if you see a Medicare patient, then you must not only abide by all rules, regulations and payment schedules for manipulation of the spine, but you must also file a claim for the patient within one year of rendering the covered services.
Often I am told by the new practitioner that they are going to have a cash-only practice. However, if you see a Medicare patient, then you must file the claim for the manipulation of the spine if it is active care.
Can a chiropractor simply not treat Medicare patients?
Yes, as long as you do not discriminate based on sex, color, creed or sexual orientation. However, you may want to consider that there are currently 80 million baby boomers in the United States who are rapidly becoming Medicare eligible.
Additionally, the Patient Protection and Affordable Care Act (Obama Care) has mandated that the Physician Quality Reporting System, which became mandatory as of January 2013, serves as the basis for its Value-Based Modifier initiative. CMS intends to move Medicare from the position of a passive payer to a purchaser of high-quality, efficient care through a value-based purchasing initiative. The Affordable Care Act mandates that CMS must begin to apply a value-based modifier under the Medicare Physician Fee Schedule by 2014. In other words, cost and quality data will be factored into the calculation of payments for physicians.
Starting in 2015 with hospital-based physicians, some payments will be affected by the value-based modifier. By 2017, most physician payments will incorporate a quality calculation. Given this fact, participation in PQRS, available only with Medicare treatments, offers doctors a valuable opportunity to prepare for the transition from fee-for-service reimbursements to payments based on quality performance.
Conclusion
Lastly, I personally find it very rewarding to treat elderly patients. They frequently will break down crying in thanks for the pain relief they have gained through chiropractic. If you are not currently enrolled with Medicare and are seeing Medicare patients with chiropractic services, you may be liable for significant fines and possible loss of license. Check with your Medicare carrier or with the Illinois Chiropractic Society regarding how to enroll appropriately with Medicare.
Upcoming Courses:
Dr. Fucinari and the ICS will be presenting several classes in the coming months to aid the doctor and staff in correct compliance procedures. For an updated schedule of classes and locations, go to www.illinoiscme.com or www.AskMario.com. Dr. Fucinari is a Certified Medical Compliance Specialist and a Certified Insurance Consultant. He is the Chairman of the ICS Medicare Committee. For further information on compliance audits, insurance consulting, books or record reviews, please contact Dr. Fucinari at Doc@Askmario.com
