Medicare parity is ACA's top legislative and regulatory priority. In order to best serve their senior patients, chiropractic physicians should be allowed to practice to and be reimbursed for the fullest extent of their licensure, training and competencies.
The federal Medicare program, which serves as a model for private insurance plans, currently serves more than 55 million individuals. Various projections forecast the number of people age 65 or older increasing by about one-third over the next decade. Chiropractic inclusion in the Medicare program was established in 1972 and has seen little change since then, other than elimination of the X-ray requirement in 1997.
What does this legislation mean for me and my Medicare patients?
Simply put, the bill, and ACA’s entire Medicare initiative, is to ensure patient access to all Medicare-covered services that DCs are licensed to provide. Again, it is important to note that our initiative adds no new services. It only allows access to those current Medicare benefits that chiropractors are licensed to provide. The current statute that governs patient access to Medicare has been in place since 1972. It’s antiquated and does not reflect the acceptance of chiropractic into mainstream health care. In addition, it limits patient choice, which is a highlight of our educational efforts with legislators.
What happens next?
ACA is now working with the 116th Congress to reintroduce the bill. Nearly 20 percent of Congress is new to Washington. This represents a significant amount of outreach and education required to keep the momentum established in 2018.
Even so, the bill’s introduction is an important milestone. Our ideas have been drafted into legislative language that will be more familiar to all involved, and the bill’s support in the last session paves the way for reintroduction.
Which codes are covered by the proposed bill?
If and when bills become laws, the federal rulemaking process determines implementation. Details related to codes, reimbursement and billing will not take place until then.
It’s not known exactly which codes would be covered. At a minimum, if passed in its current form, the legislation would include selected evaluation and management (E&M) codes, post therapy, and certain x-ray codes, if applicable.
Is the option to opt out of Medicare included in the new bill?
The first step is to put chiropractors on par with all other physicians within the Medicare system. This lays the foundation for patients to receive covered services from their chiropractors to the full scope of their state license, and makes it possible to work toward other improvements. Opt-out options may require further legislation.
During a Facebook Live Event in late 2018, ACA talked about the opt out issue with our lobby team from the Capitol Hill Consulting Group
In Section 3 of the bill, what does the provision regarding “Certain Coverage Limits” mean for me?
This provision was added at the request of legislative drafters to support the provision that was included in the 2015 Medicare Access and CHIP Reauthorization Act, better known as MACRA. Included in MACRA was a requirement (Sec. 514 of Public Law 114-10) that CMS develop a process for medical review, and potentially place on prior authorization, chiropractors who have aberrant billing patterns.
What this bill means is that chiropractors will be able to bill Medicare for the full scope of their services allowed by their state, provided they have not been identified as having billing patterns much different than their peers. This would be a significant expansion to ensure we can continue to care to our patients as they age.
However, the inclusion of this provision shows the seriousness of Congress to take on what it feels are inappropriate payments. In order to fully allow chiropractors unfettered access to Medicare billing, the profession will need to continue to address this issue head on and the ACA stands ready to help all chiropractors to meet that charge.
Check out Learn ACA's Medicare Training for the Chiropractic Office to improve your documentation in Medicare and earn CE.
Medicare Training for the Chiropractic Office
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Ask your patients, family and friends to sign the petition:
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We encourage ACA members, SACA students and anyone else with an interest in further integrating access to chiropractic services in Medicare, to urge patients, friends and family to sign the petition calling on Congress to change the current Medicare statute. Point your patients, friends and family to https://www.acatoday.org/equality/doctors where they can become part of the campaign to provide full patient access to services provided by doctors of chiropractic in Medicare.
Urge your state association leaders to Urge your state association leaders to sign the open letter to Congress expressing support for changing the antiquated statute that chiropractic patients currently face. This will show Congress that there is solidarity within the profession to ensure that patients have access to the essential services that doctors of chiropractic provide.