Never having participated in Medicare I am unfamiliar with all the “ins and outs” of the program. I am continually getting emails, calls, and letters from people telling me that I cannot take care of Medicare practice members without being part of and billing Medicare. It’s interesting that we have a health care bill now before Congress which no one seems to be able to read or understand, yet every chiropractor and every chiropractic college instructor and every practice management consultant seems to understand exactly what the Medicare regulations say. I appreciate everyone’s concern that some government official will come into my office flashing a badge and arrest me for adjusting senior citizens and not billing Medicare. I guess I have been fortunate for the last 43 years. I have been adjusting senior citizens almost since the inception of Medicare and no one has bothered me. I can see why chiropractors do take Medicare. The Office of the Inspector General published a study in May 09` stating that chiropractors were reimbursed a total of $466 million in 2006. However, they also estimated that $178 million of that was inappropriately paid, amounting to almost 40% of claims. And I should worry about being charged for billing Medicare nothing? I don’t think so.
The study said that chiropractors were submitting claims for mere “maintenance therapy.” Further, they concluded that chiropractors “often do not comply with Medicare documentation requirements.”
Now does anyone really think that the authorities are going to come after me because I do not take Medicare (and no one is complaining) when 40% of the chiropractors seem to be inadvertently or purposely ripping off Medicare? If the senior citizens do not want to drop payment for service in the box, they can go elsewhere. I am happy with my situation. The government doesn’t have to go through my files to see who I am taking care of illegally (which I don’t think they are permitted to do anyway). My practice members are happy and I save a ton of paperwork.
I’m sure there are people out there who will be expecting The Pivot to start coming from a federal penitentiary but I fully expect to be free and taking care of people in the future the same as always.
With that said let me give my take on the Medicare and chiropractic’s situation. I must preference my remarks by saying that I am not an attorney. I do not know anymore about Medicare regulations than the average chiropractor. (Nor do I know any less). We all understand that regulations are written by attorneys and government bureaucrats who do not want the average person to understand the regulations. For that reason I may be totally wrong on my reading and understanding of the regulations but here goes:
This is a free country (at least it was when Medicare came into existence). No one was required to participate in Medicare. I never received a notification that I was now able to “join” Medicare. I recently received a notification that I could sign up for Medicare because in March 2010, I will be 65. That is the point. Medicare is not a “doctor program” it is a “citizen program.” Subsequent to its inception in 1966, no one has ever said that I must participate. You opt for Medicare. Here is something that may be difficult to understand for some chiropractors. If you don’t choose to get in, you don’t need to opt out.
Actually, the government recognized that medical doctors may want to opt out someday (because they could no longer make a decent living being paid by Medicare) so they gave doctors the freedom to opt out. Here is the point. They do not opt out of Medicare, they opt out of taking care of Medicare patients. In other words, they can take on new people over 65 outside of Medicare (if the people are willing). Here is the interesting part: you can also take care of people over 65 outside of Medicare who were receiving Medicare if you decide that you cannot afford to take care of Medicare people any longer. That is opting out. It is an involved process.
None of the above is applicable to chiropractors from what I have read because supposedly chiropractors cannot opt out. I have no idea why that is and I am only going on chiropractors’ interpretation of the law saying you cannot. Why would they write a Medicare law allowing medical doctors to opt out and not chiropractors? I can think of a few reasons but it would be conjecture. The point is that opting out is not relative to new people who come into the office for the first time, only those who are already being adjusted under Medicare. It is not relative to those like myself who have never “opted” in. Last but not least, Medicare does not pay for “maintenance” care so all you have to do is agree with the practice member that it is maintenance care and you cannot be paid through Medicare. Sounds confusing? Wait until we have socialized medicine! Meanwhile, if you want to stop taking Medicare money, do not take anymore Medicare patients, just take senior citizens and develop a system for them and put all your present Medicare practice members on maintenance care. If you are just starting out don’t get involved in Medicare.
I’m sure there are people out there who will disagree with my interpretation of the Medicare regulations. You can rebut what I have written, and I will print a retraction but please don’t cite some chiropractors or chiropractic institution’s interpretation. Use only Medicare regulations. I no longer care what chiropractors say that Medicare says, only what Medicare says and only as long as it agrees with the law of the land–the United States Constitution. V25n2