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Wednesday, September 28, 2011

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.

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