QUESTION:  Should I participate in the Medicare program and how do I find out about getting started?

ANSWER:  Medicare is a complex, demanding program from which doctors of all types gain little profit and many headaches. It is, however, a massive program that serves America's elderly population, a population that is rapidly growing and will top out at around 55 million people in the years ahead.  Medicare benefits are mandates, which means they are like civil rights.  You cannot assign or wave those rights.  This is true for the beneficiary as well as the doctor.  If you provide chiropractic adjustments to a Medicare patient, that patient is entitled to have that care paid for and you are entitled to the payment the government provides.  Even seeing Medicare patients for free has potential complications.  There may be some circumstances where a doctor of chiropractic may find it advisable to decline to see Medicare patients, but on balance, it makes sense to participate. 

Medicare paperwork is time consuming, confusing and frustrating since it is hard to get direct information on what the administrators of the program want, what the parameters are as far as numbers of visits, when rules and procedures change, etc.  Our elderly patients, however, need chiropractic care perhaps more than any other segment of the population since chiropractic can provide the two things older people value more than anything else in health care; clarity of mind because chiropractic is a drugless science; and assistance in maintaining their mobility.  Doctors of chiropractic have an obligation to care for this special population, in spite of the difficulties.  Otherwise, those people are at the mercy of a medical system that cannot duplicate what chiropractic has to offer.  It is the right thing to do.  And, because of the contact this program can give you with so many in your community, it is a good referral system since the families of those elderly patients have a personal awareness of chiropractic and of you as their family's chiropractor. 

Medicare has divided the country into administrative regions and has contracted with companies, called a "carriers" to administer the program in each region, to process claims and be the third-party link between the national program administrators and providers.  While many aspects of Medicare administration are standardized nationwide, there are many regional variations as Medicare allows regional carriers a good deal of discretion on how they administer the program, including discretion on utilization screens and thresholds.  In addition to carefully reading all the government and carrier information, also talk to a local colleague to gain their added insight into how the regional contractor that administers the program works. 

With the advent of the Internet, it is now a little easier to get information on Medicare.  Recently, the agency that runs the program, the recently re-named Centers for Medicare and Medicaid Services (CMS), formerly known as HCFA, has asked ICA's help in promoting a new website that offers good information on Medicare for providers and beneficiaries alike, including signing on as a Medicare provider.  Forms, program directives and answers to common questions are available on CMS's multi-level site.  Called the Medicare Learning Network, the site can be accessed at http://cms.hhs.gov/medicare/.  NEW PRACTITIONERS CAN ENROLL AS A MEDICARE PROVIDER DIRECTLY THROUGH THIS SITE.  LOOK FOR THE PROVIDER-SUPPLIER ENROLLMENT LINK ON THE SITE TABLE OF CONTENTS ON THE MAIN PAGE.

A good example of the utility of this new on-line resource is the immediate availability of information on Medicare's new Advance Beneficiary Notice (ABN) form.  The new Medicare ABN form is the official form that Medicare providers must use to notify beneficiaries when there is a likelihood that a service will not be paid for by CMS.  This applies to covered services, which, because of limitations, caps, etc., may not be covered to the full extent of the bill.  Please note that this form is not required for every visit but only those visits for which you have some reason to believe (based on Medicare's payment history and patterns in your region) might not be paid.   This form is available online at http://cms.hhs.gov/medicare/. Medicare has published the following information and links on the ABN:

Advance Beneficiary Notices advise beneficiaries, before items or services actually are furnished, when Medicare is likely to deny payment for them. ABNs allow beneficiaries to make informed consumer decisions about receiving items or services for which they may have to pay out-of-pocket and to be more active participants in their own health care treatment decisions. Medicare Announces New Patient Liability Notice: In June 2002, the agency published revised Advance Beneficiary Notices (ABNs), which may be used in connection with Medicare claims. The new ABNs are part of CMS's Beneficiary Notices Initiative (BNI). Go to the BNI Web Page to see ABNs and other BNI notices. They are designed to be more beneficiary-friendly, more readable and understandable, with patient options more clearly defined. There are two CMS-R-131 forms, the General Use form ("ABN-G") and the Laboratory Tests form ("ABN-L"). Both CMS-R-131 ABN forms are standard forms which may not be modified. Both contain customizable boxes for the individual use requirements of users, following the guidance in PM-AB-02-114.

Be prepared to be patient, deal with an unreasonable amount of paperwork, and to accept a minimal payment for each visit.  You will always have the satisfaction that comes from caring for grateful patients who genuinely need your care.