More info

For more information on how to bill Chiropractic Medicare please visit

Thank you for your interest!

Wednesday, September 28, 2011

Illinois Senate Bill 1843 letter from Dr. Michael J. Hulsebus, FICA, LCP, Member of International Chiropractor AssociationMember of Illinois Prairie State Chiropractic Association

Chiropractic Medicare reimburses chiropractors (or our patients) for only one thing.
Correcting a vertebral Subluxation.
NOT "treating" symptoms.
Medicare is an excellent "Chiropractic" program.
Chiropractic is the ONLY healthcare discipline providing health care without the use of drugs or surgery!
(Is this really true?)
Please take a moment to look at the letter below from Dr. Michael J. Hulsebus, FICA, LCP, Member of International Chiropractor Association, Member of Illinois Prairie State Chiropractic Association.
You will have an accurate idea of what a small unhappy group of chiroprators are attempting to do across state after state.
Best regards,
Dr. Street
    Illinois Senate Bill 1843 letter  
    After the passage of Illinois Senate Bill 1843, it is appropriate to follow up about what happened, to amplify lessons learned, and to gird ourselves for the inevitability of more far-reaching legislation in the months ahead. 
    As many of you know, the recent minor change in the Illinois law (awaiting the governor’s signature) authorizes chiropractors to give advice on “non-prescription products,” including a variety of over-the-counter substances. (Actually, there never was a law forbidding us to do that, but now doing so is protected under Illinois law.) The law also now allows chiropractors to prescribe, dispense and administer oxygen.  
    What you may not know—but ought to—is that Bill 1843, as originally crafted evidently by the leadership of the Illinois Chiropractic Society (ICS), changed language in the Illinois Medical Practice Act (IMPA) that defines a chiropractic physician as one “licensed to practice without drugs and operative surgery” to read “…treat human ailments without operative surgery and without the use of prescription drugs….” By inference from that language, chiropractors could legally administer non-prescription drugs, including drugs that initially required a prescription from a medical physician and later sold over the counter.  
    That original bill of six pages, which, if passed into law, would have overnight virtually breached the wall in Illinois between medicine and chiropractic, was quickly quashed by medical interests—in fact, so quickly that most Illinois chiropractors didn’t realize the legislation was on the table. Subsequently, Bill 1843 was sent back to the Senate in its diluted form of three pages and slipped into law. The final version, the thin edge of a wedge, just dents the wall between the two health care professions. 
    However, we all need to be aware that the original bill is a harbinger of things to come in Illinois and elsewhere.  
    That original Illinois bill was reminiscent of one introduced in the New Mexico legislature earlier this year. According to its sponsors, the purpose behind their bill was to address an alleged shortage of primary-care physicians in New Mexico, a situation supposedly worsening with federal health care reform. The New Mexico legislation, which was defeated (at least for now), would have allowed chiropractors to prescribe certain drugs after advanced training. Santa Fe chiropractor Stephen Perlstein, one of the bill’s sponsors, was quoted as saying, “We’re trying to do this within our own profession and expand our profession.” 
    As the New Mexico situation makes clear, the more medically oriented elements of our profession, such as the leadership of the ICS, see the perceived need for more primary-care physicians as an opportunity to expand chiropractic’s scope of practice to include dispensing medicine. For example, James Winterstein, D.C., president of National University of Health Sciences in Chicago, has argued along that vein.
    Of course, meeting a perceived public need is not the only motive. Getting more patients to come to what Dr. Perlstein described as “one-stop-shop” chiropractic offices likely would mean increased revenue for those chiropractors. It would also mean increased revenue for some chiropractic colleges, most notably National University of Health Sciences, who want to offer, toward an advanced degree, education in materia medica and other aspects of medicine and surgery. On the other hand, chiropractic colleges with strong philosophical aversion to mixing in medicine would likely be at a competitive disadvantage. In a relatively short time, chiropractic in Illinois and elsewhere could be transformed into a hybrid, not unlike osteopathy. The pro-drug advocates see a two-tiered chiropractic profession, the upper tier being more like medical physicians and the lower tier filling the traditional chiropractic role. 
    So what’s wrong with expanding our profession in this way, especially since it supposedly would put more money into our pockets? What’s wrong is that expanding our professional this way is to invite in a Trojan Horse that could capture the chiropractic profession and diminish much of the good it accomplishes. Not just chiropractors, but also the public we have sworn to serve, would be the victims.  
    The Trojan Horse of Greek literature was looked upon as a fortuitous gift, but it turned out to be the vehicle of Troy’s demise. Thus it is said to be the source of the popular warning, “Beware of Greeks bearing gifts.” Likewise, opening our gates to medical practices inevitably would mean the loss of our identity as a separate profession. The loss to society would be the dilution, some would say corruption, of a profession that, in the words of a memo from the International Chiropractors Association (ICA), “has filled this role (as a drugless, non-surgical profession) with proven clinical and cost effectiveness for more than 100 years.” 
    The Illinois Prairie State Chiropractic Association (IPSCA) joined with the ICA in opposing the final and weakened version of Bill 1843. In voicing its reasons, the ICA’s Political Action Committee contended that giving chiropractors the right to give advice on “non-prescription products” puts the public at risk. The ICA memo noted that 300,000 people die as a result of pharmaceutical and medical errors and that $177 billion in excess costs in the health care supply chain can be attributed to medication errors, 80 percent of that tagged to physician error. The memo stated that “this is not…an environment in which any practitioners can make a safe and effective contribution with less than a gold standard set of qualifications and credentials.” Observing that the final version of the bill didn’t require any additional education for giving drug advice or prescribing and administering oxygen, the ICA urged that the watered-down bill be defeated. 
    All that’s true enough, but how much more public danger would there be if chiropractors get licensure, not just to advise, but to prescribe and inject drugs? The over-prescription of medications with their deleterious side-effects already is an onerous burden on the American health care system. What the system needs today more than ever is strong advocacy on the preventative side of the health care spectrum. Indeed, a ground swell of public opinion clamors for conservative care using natural methods and health care education, not further ingestion of seemingly quick-fix but too-often-deadly chemicals. In fact, many people throughout the country use their chiropractor as a primary care physician because they want conservative care as their point of entry into the health care system. What this country needs is not more primary care medical doctors (although perhaps they could be more equitably distributed throughout the country) but far more primary care chiropractors, who can help people through natural means unless there is a real need to refer them over to a medical physician or surgeon.  
    Rest assured that, when any legislation surfaces that puts the public at risk and threatens to erode the dignity and credibility of the chiropractic profession by seeking to include drug prescription/administration rights,  the more centered and less opportunistic majority of chiropractors, represented in Illinois by the IPSCA and nationally by the ICA, will be in the forefront of the fight to secure its defeat. It is so clearly the right thing to do for both the profession and the public. 
    Why is it, though, that some in our profession are so desperate to have drug dispensing rights? The reason is simply that they have lost confidence in (or perhaps were never taught) chiropractic’s fundamental principles and have shifted into the medical paradigm. They wish to use whatever therapies they can in the treatment of symptoms, even if that includes drugs or surgery.  The chiropractic profession, as a whole, has never endorsed a mixture of chiropractic and allopathic medicine.  But this does not stop the fringe element that strives for the expansion of the chiropractic scope of practice.  
    So, with little confidence in the efficacy of the chiropractic adjustment, the graduates of schools like National are left with little more to deliver than physical therapy and other mild forms of treatment. They evidently believe they need to prescribe drugs in order to position themselves as economically viable. 
    In his frequent and long-standing arguments that chiropractors ought to be granted prescriptive rights, Dr. Winterstein says that restricting ourselves to historic chiropractic principles allows insurance companies to “paint us into a corner” with coverage limited to musculoskeletal conditions. While that may be true, the fact is that chiropractic has proven effective for far more than musculoskeletal conditions, and we have thousands of satisfied patients to prove it. We also have many prospering cash-only practices as proof of that patient satisfaction.  
    It is beyond the scope of this letter to put forth all the powerful arguments against chiropractors’ prescribing drugs. For a good overview of those, check the recent article in Dynamic Chiropractic by James Edwards, D.C., who lists among the dangers:
         ● loss forever of our unique identity as natural healers,
         ● dramatically increased cost of malpractice insurance,
         ● loss of cross-referrals from medical doctors, and
         ● the public relations nightmare (and, we might add, litigation nightmare)
          when somebody dies of a “drug prescribed by a chiropractor.”  
    And something else. It may seem remote now, but at some point, as the chiropractic profession continues to gain credibility for clinical success, the rich and powerful pharmaceutical industry may see us as another potential revenue stream. Watch for it to start negotiating with medical physicians to share drug prescribing rights, at least for some conditions, with chiropractors. When the pharmaceutical industry puts its lobbying muscle behind legislation to let chiropractors dispense drugs, the medics may not be able to stop it. 
    Will some in our profession be seduced by the lure of the almighty dollar? Free samples, trips to the Bahamas, kickbacks for prescribing new me-too drugs—these gifts and more await our profession once new laws are passed. Ironically, many medical doctors are uncomfortable that their practices have been co-opted by the drug industry. Whereas those primary care physicians might prefer to offer more conservative care, they are simply overwhelmed by the billions of dollars spent by the pharmaceutical giant in marketing to them as well as directly to consumers. Will chiropractors, in their naiveté, make a similar mistake? Will all of us suffer—along with a public in desperate need of drugless care—as the lamentable result? 
    There, beyond the wall. Is that a giant horse? Our profession ought to beware of Greeks bearing gifts.     
    Submitted by: 
    Member of International Chiropractor Association
    Member of Illinois Prairie State Chiropractic Association

Self Audits for Chiropractors ~ Sept. 26th

The Question: "How can you be successful in a self audit if you don't know how to do it correctly in the first place?"  The "self audit" concept will help fellow Chiropractors and staff understand the depth of responsibility we are soon to be under.

As I prepare the Chiropractic guidelines for a step-by-step map to help Chiropractors become compliant in Medicare, "Self Audit" stands out as a little unusual in outcome. Because of the Inspector General's report, most carriers "believe" they have over paid Chiropractors large sums of money.  The majority of Chiropractors have no idea how to "document" the Chiropractic necessity of care by "federal standards."  However, nearly all Chiropractors get paid by Medicare (96.4%) and because of that chiropractors "believe" they must be doing Medicare correctly.  Results of audits on Chiropractors have proven otherwise because most Chiropractors having audits lose. They end up paying back that in which the Medicare Carrier paid plus fines.

The Reason:  They believe they know how to do Medicare - but they do not.  And since the majority of Chiropractors do not "document" correctly, the Medicare Carriers due to the Inspector General, have agreed that if there is NO correct documentation for a Medicare patient, it should be a non-covered maintenance care service.  They want, and are getting, the money back.
So doing a "self audit", when you don't know the correct way to document in the first place, is quite questionable.

Here is the Answer:  Those who have attended our Seminars over the past 10 years, and those with "The Basics" Chiropractic Medicare DVD's, review and follow the information you have.  The audit success rate is fabulous as long as you do what the seminar and/or DVD presents.  You are the ones that will be able to do "self audits" successfully.

Maintenance Care? ~Sept 19th

"Maintenance Care" in my Chiropractic office is when a patient enters my office, they are checked, have NO subluxations and they go home.  The Medicare Program has twisted Chiropractic minds so Chiropractors forget that we have but one job in Medicare; find, prove and correct vertebral subluxations (vertebral displacements). That is all that is reimbursed to Chiropractors in the Medicare Program.

Patient symptoms are used by Chiropractors to help locate the subluxations and/or malfunctions of organs.  Just because the patient has NO symptoms does not mean the patient has NO subluxation and is now "maintenance care".  The patient has either a new condition, exacerbation, accident, neuronal component or chronic state.
To meet Medicare coverage criteria, a chiropractic office visit adjustment should be aimed at correcting subluxations related to acute injuries/reinjures or exacerbations.  The result of the Chiropractic adjustment is expected to be an achievable improvement and with a clearly defined point.  Once the maximum benefit has been achieved for a given condition, on-going maintenance therapy is not considered medically necessary under the Medicare Program.

Maintenance therapy is defined by Medicare as a treatment plan that seeks to prevent disease, promote health and prolong and enhance the quality of life, or therapy that is performed to maintain or prevent deterioration of a chronic condition.  Medicare does not cover maintenance therapy.
The recommendation here is: be a Chiropractor and prove the subluxation.  Document by "Federal Standards".  Listen well to the patient and correct vertebral displacements (subluxations).  Medicare has excellent Chiropractic coverage as long as we practice like Chiropractors.  If you are correcting vertebral subluxations for your Medicare patient and calling that adjustment "maintenance care" because you do not know how to document, then you have just performed a covered service in Medicare, did not "document the Chiropractic necessity of care", and cheated your patient from Medicare reimbursement. 

Remember....correcting the vertebral subluxation is the only covered service in Medicare.....and the only service we Chiropractors are mandated to bill to the Medicare Carrier. Performing a covered service and not billing that service, because of lack of knowledge or thinking it does not have to be documented or billed, is unfair to the consumer, your patient and to Chiropractic in general. As a Medicare provider, you signed a contract with our government so you have the privelige to see Medicare patients.... and that YOU will know and follow the Medicare guidelines.

Tuesday, September 13, 2011

Quitting Medicare

First of all, you must understand that if you continue to provide the payable service of 98940, 98941 or 98942 to any patient that has Medicare coverage, you cannot "Quit" or disassociate yourself from the Medicare Program. 

The only way to avoid the Medicare rules is to provide your covered services for "free" to the Medicare patient, or refer them to other offices that accept Medicare. If you have a Medicare Provider Number, that means you signed a contract giving you privilege to provide Chiropractic adjustments for Medicare consumers, and that you will know and follow all Medicare guidelines.

Chiropractors cannot "OPT-OUT" of Medicare.  You can either adjust Medicare patients and follow the guidelines or provide "free" adjustments or not adjust Medicare patients. How do you get out of paying taxes? You don't. Remember: Medicare is a U. S. Government Program.  Do it correctly or don't do it at all!

If you are correcting vertebral subluxations that is a covered service in Medicare. When you provide a covered service, you must bill Medicare in a reasonable amount of time, one year or less.  Both participating and non-participating providers must collect the 20 % not paid by Medicare, from your patient or their supplemental insurance.  It is against the law to practice "NO out of pocket expenses" with Medicare.

Wednesday, September 7, 2011

NEW Advance Beneficiary Notice of Non-Coverage (ABN) CMS-R-131(03/11)

NEW Advance Beneficiary Notice of Non-Coverage (ABN)

The centers for Medicare and Medicaid Services (CMS) has released a revised Advance Beneficiary Notice of Non-Coverage (ABN) CMS-R-131 form, The ABN is issued by providers where, depending upon a situation, Medicare payment is expected to be denied.  That includes a covered service in which the doctor believes Medicare will not pay and all non-covered services billed to Medicare.

That also includes referral of a Medicare patient for any service by another health care provider including a covered service.

NOTE:  The only differences found on this revised ABN and the prior is the date of issue on the bottom of the form.  CMS-R-131(03/11)
This specific form has a mandatory use date of November 1, 2011.

Option # 2 is the primary change from the original ABN.  Please keep in mind, Option #2 is used ONLY for non-covered service.  Taking a covered service as 98940, 98941 or 98942, calling it maintenance care, with the patient checking Option #2 and not billing the Medicare Carrier for the Chiropractic adjustment is "thin ice" maneuvering.

The Chiropractic adjustment is the only reimbursable service for Chiropractors.  When a Chiropractor adjusts a patient to correct a vertebral subluxation, then that is a covered service in Medicare not maintenance care.

The doctor must learn to honestly and specifically "document" the Chiropractic necessity of care by "federal standards."  The patient who has a subluxation has had either an accident, exacerbation, or a specific "Neuronal Component".  It is the doctors job to prove the subluxation, document the cause of subluxation, and correct the subluxation with an adjustment.  That is a covered service by Medicare.

Chiropractic Medicare X-rays (Newsletter from 8/29)

Chiropractic Medicare X-Rays ~ Newsletter from August 29

Medicare is an excellent Chiropractic program.  No other insurance company, PPO, HMO, etc., requires Chiropractic Philosophy, Science and Art as in the Medicare guidelines. Chiropractic Medicare was written by chiropractors (Dr. Day, Dr. Hulsebus, etc.)

There are two(2) parts to Chiropractic Medicare to make a mandatory claim:
    1.  The Chiropractor must prove a vertebral subluxation.
    2.  The Chiropractor must "document" the chiropractic necessity of care by "federal standards."

I strongly recommend doing x-rays on each Medicare patient.  (P.A.R.T. is weak and can be challenged, where as, using your x-rays, you are the authority in regards to locating subluxations.) 

You must have a minimum of two views of each region you adjust (AP & Lateral).  The films must be of good quality and evidence of collination.  The x-ray films must be on location or in a location the doctor has access too, as the Medicare carrier may request those films as they did at the beginning of Chiropractic Medicare.

I suggest doing the following x-rays on each Medicare patient each year.  (If the doctor proves vertebral subluxation by way of x-rays, then the Chiropractor must have a new x-ray that is not over 12 months old, or the Medicare claim will be denied.)
    1 14x36 AP full spine
    1 8x10 Lat. Cervical (including occipital)
    1 7x17 Lat. Thoracic
    1 7x17 Lat. Lumbar (including Sacrum and coccyx)

Chiropractic x-rays are important in that it helps locate vertebral subluxations, pathologies, etc., and they are mandatory for we Chiropractors that use them to prove a subluxation.