Medicare Demonstration Project

 

Introduction
News
Resources (General & Billing Info, FAQ)
State Specific Info
Incident to & the Demo Project
How does this affect you?
Now What? Timeline
 

As part of legislation overhauling the 38-year old Medicare program -- passed by the House of Representatives on November 22nd and the Senate on November 24th, 2003 - President Bush authorized a two-year pilot project designed to test expanded access to chiropractic services for America's seniors. This portion of our website is designed to make sure that interested doctors and other parties have access to all the details about the Medicare Chiropractic Demonstration Project, including information about related ACA seminars and the ACA legislative action that helped create this unprecedented opportunity.


 

News

 

Resources

Centers for Medicare and Medicaid Services

Medicare Learning Network (MLN) Matters Articles are provider education tools created by CMS. These are three such articles which deal with the demonstration project. These articles have the latest details of the demonstration project, including CPT and ICD9 codes, information for radiologists and clinical laboratories, billing instructions, affected areas, and other relevant information.

According to its website, 'the Federal Register is the official daily publication for rules, proposed rules, and notices of Federal agencies and organizations, as well as executive orders and other presidential documents.' This particular link will take you to the Federal Register notice about the chiropractic demonstration project.

The ACA has developed a draft letter for DCs in the demo areas to send to their local newspapers to raise awareness of the demo project. Please feel free to take this letter, make it your own, and spread the word about chiropractic!

 

State Specific Information

State Associations Medicare Carriers CCAC Representative Beneficiary Fact Sheet*
ME NHIC Dr. Thomas Augat Click Here
IA Noridian Dr. Kevin Stapleford Click Here
IL WPS Dr. Carlos Boileve Click Here
VA Trailblazers Dr. Nelson Gregory Click Here
NM Arkansas BC/BS Dr. Gretchen Peterson Click Here
*Please be advised that for the states of New Mexico and Illinois, the Beneficiary Fact Sheets are also available in Spanish. Click here to visit the official CMS Demonstration Project Site which has these fact sheets.
 

"Incident To" & the Demo

“Incident to” is a phrase that describes the delivery of certain services through an individual other than the actual healthcare practitioner (e.g., electrical stimulation performed by a chiropractic assistant ‘incident to’ a doctor of chiropractic). The current discussion about the ‘incident to’ regulations is related to standards surrounding the delivery of physical medicine services.
As of July 25, 2005, for therapy to be reimbursed under the Medicare Demonstration Project, the therapy must be delivered by either a physician or someone that qualifies as a “therapist” (e.g., a physical therapist).Click here for general information on “incident to.”

 

How does this affect you if you’re a DC in the demonstration project?

You have some options:

  1. If your assistant meets the qualifications outlined in the “incident to” regulation, you can have them perform the service and it will be reimbursable.
  2. You can perform the service yourself and it will be reimbursable.
  3. For some or all of the time, you can have an individual who does not meet the qualifications outlined in the “incident to” regulation perform the service (e.g., a chiropractic assistant), but it will not be reimbursable.  In this case, you will need to bill the service(s) on your “non-demo” claim with a GY modifier (in addition to the –GP always required on physical medicine services).
 

Now What?

ACA will analyze the results of the Chiropractic Demonstration Project and determine how best to use this information to influence change to the Medicare covered services for doctors of chiropractic under Medicare.

ACA strongly recommends that all DCs concentrate on getting as many of their patients as possible into chirovoice, the patient advocacy network.  Members of Congress listen to their constituents, and the more constituents ACA can contact to engage in grassroots action, the more likely it is that Congress will act on the results of the demonstration project in a positive way for chiropractic.