October 8, 2012
Federal Guidelines and
Seminar Dates: Washington, Oregon, and Florida!
Medicare carriers across America, with the approval of CMS, have and are doing the job on chiropractic care. First, they have led chiropractors away from that inwhich chiropractic is all about, locating and correcting vertebral subluxations.
The Federal Guidelines click or follow this link to CMS (Medicare) website:
The Federal Guidelines indicate the primary and ONLY job of a chiropractor in Medicare is to locate and correct vertebral subluxations. Back in 1973 we were mandated to take x-rays to prove the subluxation and once proven, we were reimbursed to adjust those subluxations. There was and still are NO limits in Medicare for the chiropractic adjustment.
Over the years the Medicare carriers have led the chiropractors down the yellow brick road of “treating” patients symptoms. Developing a “treatment plan” specifically related to the patient’s symptoms and NOT related to the correction of a vertebral subluxation which is indicated by Federal guidelines.
Now the past years statistics on chiropractors indicate chiropractors treating patient symptoms are doing a poor job of documenting the necessity of treatment care so the Medicare carriers believe we are billing for maintenance care since most chiropractors have no idea the correct way to “document” the chiropractic care necessary.
Chiropractors should practice like chiropractors. Use the patient’s symptoms for diagnosis, locating the problem and decision making, but do not “treat” patient symptoms. There are plenty of other health care provider that ONLY treat symptoms.
Consider this scenario: New 74 year old patient comes into your office for chiropractic care after picking up a box at home hurting his low back. You do the workup including exam and x-rays and find a subluxation of L5. It has only been there 35 years….. you know that because it has proliferating arthritis that has been developing for the past 34 years because he never got it corrected. The L5, S1 articulations has soft tissue insult, swelling, etc., indicating sprain/strain. (diagnosis: 739.3, arthritis, sprain/strain)
This is an exacerbation on a new patient, soft tissue tear in a predisposed chronic subluxated, degenerative joint. By “documenting” this specific event correctly, this exacerbation is worth up to 6 visits. However, if chiropractors listen to our patients and understand the most active patient’s in your practice are your seniors, you will soon find your seniors have all kinds of exacerbations. Your job is to locate the subluxation, document the exacerbation by Federal Guidelines and correct subluxations.
Many Medicare carriers across America have stepped up and set specific visit guidelines for Medicare patients. Even though the Federal chiropractic guideline says there are no limits in Medicare for the chiropractic adjustment.
If you are in one of these states, (Tennessee, New Jersey, etc.) and you do chiropractic Medicare correctly and meet your carrier limit, go through the appeals process. Once you get to the Administrative Law Judge, if you have done your job like you have learned in our presentation or DVD, you should have a positive return from the ALJ.
QUESTIONS OR COMMENTS? Please give me a call.
Gary R. Street, D.C.
400 S. West Street
Olney, IL 62450
Fall Seminar Schedule:
King Oscar Hotel, Pacific, WA 8:30 am to 12:30 pm
Staybridge Suites Mukilteo-Everett, Mukilteo, WA, 6:00 to 10:00 pm
Portland, Oregon Medicare Presentation 8:30 am to 12:30 pm
Orlando, Florida Medicare Presentation 8:30 am to 12:30 pm