Seaside Chiropractic has chosen to not be a Medicare provider and not be a participating provider in the Medicare system. Medicare has a long list of laws that a doctor is required to follow in order to get paid by the Medicare system. For a large organization such as a hospital or a large group of medical doctors it’s worth the organizations efforts to pay the legal fees to have their documents reviewed on a regular basis, and to have their procedures reviewed to make sure they are following within compliance of the Medicare laws.
Medicare regulations are long, complex and changing on a regular basis. It would require tens of thousands of dollars per year, I predict, to stay in compliance with these regulations. The benefit that Medicare is willing to pay to our office in return for this work is not enough, in my opinion, to make it worth while. This morning I spoke to the Medicare office that provides information to Southern California doctors. I was told by them that their payment for basic chiropractic adjustment is $26 dollars.
Based on previous analysis I have done, I would guess it costs our office somewhere between ten and twenty dollars per claim that we submit to insurance companies, just for the submission of the claim. So unfortunately, the processing of the claim and the legal costs, and the other costs including the doctor’s time, to remain in compliance to the Medicare laws will end up costing the office more than the money that Medicare would pay to us if we were to follow all of these steps, in my opinion. So as a result of this, our office has not and will not be a participating provider in the Medicare system.
Just a final note so you can understand my position on this, I have a good friend of mine who is a participating provider in the Medicare system. My memory of what he told me was that after many years of working with Medicare and doing a good job in helping his patients and carefully documenting every visit that he saw with his patients, Medicare did an investigation of his office.
His story continued that Medicare found that the specific way that he was documenting visits in his office, was not exactly the way the Medicare regulations required you to do so, as a result of this he was fined many tens of thousands of dollars from the Medicare system. If fact, I believe, by the time it was done including fines, penalties and legal costs he had spent well over $100,000 dollars.
This was not a doctor who was committing fraud, this was not a doctor who was cutting corners, he simply (at least the way he described it to me) saw Medicare patients, documented his visits, billed Medicare and was paid for them, but did it in a way that was not in 100% agreement with the laws of the way you document each visit that was required by Medicare.
If you have further questions on this, please contact me or one of my office staff