New Medicare Chiropractic Patients
Medicare patients are responsible for their calendar year deductible and their coinsurance, which varies by year while receiving active care adjustments. Patients are responsible for paying for non-covered services including all services such as exams and modalities. This only applies to Chiropractic & Medicare. They may participate in ChiroHealthUSA or financial hardship plans to get discounts on non-covered services.
Medicare Part B covers chiropractic services. Part A covers hospital services. Everyone gets Part A if they meet the requirements, Part B costs an extra premium. Patients may also purchase Part C which is a combination of Parts A & B with certain better or additional benefits. We accept all Part B patients(check and SCAN the card), but because Part C plans require a panel, there may be no benefits for the patient in our office(most patients should know if we are on the provider list or not).
The Advanced Beneficiary Notice (ABN) is used to inform the patient that covered services might not be covered by insurance in a specific situation. The ABN is proof that we informed the patient and it is there decision to receive our services as an out-of-pocket expense, or through other insurance if they have it. See the ABN form at the end of this packet for more information.
Chiropractic Maintenance Care vs Acute Care
Maintenance Therapy is not Medically Necessary – Medicare pays for corrective care and restoration of function. They do not care to prevent disease, promote health, or prolong and enhance the quality of life. Treatment for those purposes is not payable in any form of practice.
Medicare patients will be presented with an Advanced Beneficiary Notice that will explain to them the cost of maintenance therapy in our office. The form can be found in the back of this manual. A copy must be received by the patient and a copy for the file.
In this way Medicare patients will move from active care to maintenance care. To move from maintenance care to active care, a new condition or exacerbation must occur as outlined in the Recurrence subsection of the Initial Visit Documentation section.
This is not intended to be legal advice and is only provided as an example of what our office policies and procedures are like. Please check the laws in your state before implementing any changes to your policies and procedures.