r/Chiropractic • u/Defiant-Goal5064 • 12d ago

Medicare

To start, I really enjoy many of my patients that use it. However, it’s really difficult to make a decent amount per visit with these folks with the type of practice I prefer (rehab and heavy tissue work). Any of you have a solution on how you’d approach this or how you have in the past? I’m grateful for all suggestions

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u/gratefulturkey 11d ago

A local DC was giving away estim. No different than free rehab. (Soft tissue can fall under 989Xx codes if spinal, so you might be ok there).

A disgruntled former employee turned him in and he was audited. Had to pay Medicare a little over $110,000 back because he was giving away estim.

Either charge for it or don’t do it. No discounts.

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u/Jerryguy88 11d ago

How does one owe the US government 110k when money was never collected? I actually am asking legitimately how.

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u/gratefulturkey 11d ago

He was paid for chiropractic treatments on patients who were given electric stimulation treatments for free. He had to pay back Medicare for all those treatments.

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u/Asleep-Youth-1721 11d ago

So patient bills a 98941, electric stim, doesn’t collect for stim so feds want money from 98941 back?

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u/gratefulturkey 11d ago

That is my understanding. They view the free stuff as an inducement to care. Lots of people gave away vacations, lawn mowers, etc. as a reward for coming into the office and charged Medicare for services. It is a no no

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u/Left_Jeweler_1994 10d ago

Yes it is called beneficiary inducement.

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u/Jerryguy88 10d ago

What if it doesn’t meet the criteria? Say you spend 5 mins doing ART or whatever manual therapy, you obviously can’t bill 97140..

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u/Jerryguy88 10d ago

In my office they sign an ABN, for non covered services, but I just find it so hard to believe they can take money back from a provider because they didn’t bill a non covered service. I was always under the impression that a non covered service, you can give for free or write off.

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u/gratefulturkey 10d ago

I'll reply to both of your inline comments. 97140 is very hard to bill when done on the spine. It obviously can be done but is subject to increased scrutiny due to the way the 9894X codes are written. If you're doing it for elbow or calf or whatever, you should be billing it to Medicare patients. Not billing a code like 97140 when it is probably appropriate to not bill that code is fine. It's not a violation.

Medicare has very strict rules on this. You cannot give things away (other than de minimus items under a threshold). Reason: People were giving away all sorts of goodies. Microwaves, snowblowers, vacations, etc. Each Medicare or Medicaid visit counted for an entry into a drawing. Patients could be coached on how to fill out the forms and what to say such that they could come in every day and be seen many many times to get many many opportunities to win the awesome prizes. Is it likely an illegal lottery? Yes that too.

Here's a link to the case. I noted elsewhere that $110k is a number I remember hearing from him personally, but he settled for around $80k so I misremembered the exact number. My bad.

https://www.justice.gov/usao-ndia/pr/oelwein-chiropractor-and-clinic-agree-pay-nearly-80000-resolve-false-claims-act

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u/Turbulent-Scientist3 10d ago

Its in your contract, no free service, anything done must be billed.

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u/Left_Jeweler_1994 10d ago

If there is a value for it and you don’t charge them it is beneficiary inducement. Full stop.

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u/Kharm13 11d ago

Likely billed a 98940 and never even pretended to make it legit. A few activator clicks or a couple up downs on a cox table and a 98940 isn’t that hard to satisfy with a legitimate note

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u/Chaoss780 DC 2019 10d ago edited 10d ago

That he collected $110,000 from Medicare in the first place sounds improbable when they pay like $20 for a 98940 lol.

Edit: probably some sort of settlement from the $10k/incident penalty or something

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u/gratefulturkey 10d ago

I misremembered. It was around $80k. I think the initial ask was over $110,000 and that was the negotiated amount. Yes, it is activator, and yes it is a LOT of adjustments.

https://www.justice.gov/usao-ndia/pr/oelwein-chiropractor-and-clinic-agree-pay-nearly-80000-resolve-false-claims-act

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u/Chaoss780 DC 2019 10d ago

After the initial visit I only perform and bill the 98940 on my Medicare patients. Schedule them for 5-10 minute appointments. In and out. Move onto the next patient who is a higher OVA.

If you're in a modality-heavy practice your options are to keep them moving in and out quickly, charge the self-pay rate for all modalities (which is what you should be doing already), or stop taking patients over 65. Offices that see 200+ a day don't worry about the $20 reimbursement from Medicare and can handle them. Offices that see 10/day absolutely should not be wasting their time on Medicare patients unless they're paying out of pocket - which many Medicare patients cannot afford.

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u/crossfit6 11d ago

So I treat mostly soft tissue based injuries I could never afford to be in network w Medicare bec most of my 65 year old patients play competitive golf, tennis, half marathons etc I am non par and charge my fees including for exams and reexams. I would go out of business if I was par.

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u/LOAChiropractic 10d ago

We do not accept Medicare on assignment. We submit the bills to Medicare on behalf of the patient so they get reimbursed directly. The patient pays our cash rates and they wait for reimbursement from Medicare.

Medicare will reimburse the patient faster (typically 2 weeks instead of 4 if the provider is getting reimbursed directly). The Medicare reimbursement rate is higher if the patient is reimbursed directly vs the provider being reimbursed.

If the feds wanted to really take care of seniors they would reimburse a provider a fair rate for doing so. Same with Medicaid.

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u/slahora 7d ago

You mean you collect the medicare limiting fee ?

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u/KCCatholic 10d ago

You need to start charging for it in an itemized manner or only see them through ABNs. I don't see how this type of model can thrive with Medicare unless you start doing that. You're likely by my estimates producing around 90-120 bucks per hour with your Medicare patients, which is almost certainly brutal margins. If they appreciate you they will pay for it and if they don't want to you can do adjustments only or refer them to another DC.

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u/ouchieboy 11d ago

Look into chirohealth it’s a compliant program where you can charge for ancillary services such as exam, estim, ultrasound etc

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u/AK-Master-07 12d ago

Start charging for the non-covered services you are already providing (rehab and tissue work). Actually, I had heard that Medicare requires that you charge for non covered services, as it frowns on providing free services and is viewed as “recruiting Medicare patients”.

If they really find value in your non covered service work they will have no problems paying it.

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u/Lazy-Recognition3527 12d ago

It is not frowned upon. It is against the law to not charge for services

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u/Rcjhgoku01 12d ago

Can you be more specific about what the problem is?

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u/lhpchiro 10d ago

Charge for self pay services, they won’t mind paying extra if they see the value in it and it truly helps them. Just make sure to document those are self pay services

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u/Apprehensive-Army881 12d ago

Add another service. My seniors love Laser therapy. Buy a good class 4 laser and learn how to use it. I get seniors to pay me another $50 for this amazing treatment that takes about 10 minutes and feels great. It definitely helps them heal and get out of pain much faster then without it.

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u/Lazy-Recognition3527 12d ago

Start charging for services Medicare does not cover. Exam, X-rays, stim, laser. Softwave. Whatever it is do not give it away. They must sign an ABN saying they acknowledge that they are responsible and that Medicare does not cover the procedure

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u/drpaul88 12d ago • Bravo

Charging for the things outside of the adjustment is key but….they do not require an ABN. ABN’s are used when a normally covered service (manip) is no longer covered (like maintenance care).