Just the Beginning

The Centers for Medicare & Medicaid Services (CMS) in April announced a 2-year demonstration project to expand Medicare coverage of chiropractic services in five states. The project will determine the impact on satisfaction, use of services, and costs for Medicare beneficiaries.

Effective April 1, chiropractors in Maine and New Mexico, the northern Illinois area (including 23 counties in Illinois and Scott County, Iowa), and 17 counties in Virginia can now offer Medicare Part B patients an expanded array of services they are currently allowed to provide by state law, but were not previously paid for by Medicare. These services include medical, diagnostic, and therapy services, including extraspinal manipulation or adjustment of a body part other than the spine; x-rays, electromyograms, and nerve conduction studies, clinical lab tests, electrotherapy, ultrasound therapy, and evaluation and management services. Medicare Part B covers doctor and outpatient care, and other medical services that Medicare’s hospital insurance does not cover.

For this demonstration, if a chiropractor bills Medicare for MRIs, CT scans, x-rays, and clinical lab services, Medicare will pay for it. Also for this demonstration, a chiropractor can make referrals for physical therapy services. Joel E. Margolies, DC for a private practice in Atlanta and a Chiropractic Products editorial board member, told me the program will make chiropractic care available to more people with limited and fixed incomes who previously were prevented from the proper care they deserve.

“Within the lifecycle of a community, our senior citizens deserve our respect and gratitude and should be offered the best health care available, including full chiropractic services,” Margolies said.

CMS also released a statement from American Chiropractic Association (ACA) President Donald Krippendorf, DC, who said the project benefits seniors, the Medicare program, and the chiropractic profession. But ACA Communications & Public Relations Manager Angela Kargus told me the ACA had problems with the project’s recently adopted “incident to” regulations, which will require all office staff providing and billing Medicare for incident-to-therapy services to have received training from a program recognized by the American Medical Association or the American Physical Therapy Association. This only applies to staff; the doctor can personally provide the therapy service and bill Medicare, but most doctors do not have the time to do so, Kargus said.

“Most chiropractic office staff do not have such training and also provide the bulk of therapy services in a doctor’s office,” she said. The ACA has objected to the application of these new regulations. Compounding the problem is a recent decision by CMS that doctors must fully comply with the new regulations if they want to participate in the demonstration project. “The ACA believes the application of the ‘incident to’ regulation and especially the inability to bill a nonqualifying therapy service as a noncovered service will severely hamper the project,” Kargus said.

But if the glitches are ironed out, I believe the project will greatly benefit the chiropractic profession. As the new editor for Chiropractic Products, I would love to hear your thoughts on the subject. CP

Daryl Lubinsky
dlubinsky@ascendmedia.com