Medicare

September 29, 2000

Jerry,

Thanks for pointing this out - doctors have used that line on me, too ( " not

taking new Medicare patients " ). Also, it is important to note that what the

government reimburses for Medicare patients is generally far below the

standard fees for any procedure. What this means is that the doctor's

office, hospital, or whatever will almost always be taking a loss, and this

generally means they have a strong incentive not to order any tests. In

general, this is what I find - since almost all of the tests people discuss

on this list are somewhat unusual, and many of the treatments experimental,

it is very hard for doctors to get payment. I have known non-Medicare

patients who have seen the same CFIDS doctor I see, and they received

numerous tests while I could not get her to order a simple CBC. It took

years before I found another doctor who knows nothing about CFIDS but is open

minded, and is willing to deal with the Medicare system. The fact is, the

equality clauses in Medicare simply do not play out in real life.

Peggy

<<Yes, they have to take Medicare - but they don't have to take a new patient

who is covered by Medicare. If you have already been a patient there they

are supposed to continue to treat you even if you change coverage to

Medicare, but since they aren't obligated to take new patients they can use

that as a way to avoid Medicare's puny reimbursements and horrendous

paperwork.

Jerry>>

January 5, 2001

I am in Arizona but the following is a written quote:

" The chiropractor is not required to bill excluded services, however, the

provider may bill these services to Medicare in order to obtain a denial for

secondary insurance purposes "

page 5, Medicare Special issue, January 1998, regarding " Medical policy

Chiropractic service (manual spinal manipulations)

This Medicare B News says " this applies to the following states :Alaska,

Arizona, Hawaii, Nevada, Oregon and Washington. " They faxed this to me when

I asked them about billing issues.

Anglen

January 5, 2001

That was what we understood as week

Thanks

Steve Kinne

Re: Medicare

> I am in Arizona but the following is a written quote:

>

> " The chiropractor is not required to bill excluded services, however, the

> provider may bill these services to Medicare in order to obtain a denial

for

> secondary insurance purposes "

>

> page 5, Medicare Special issue, January 1998, regarding " Medical policy

> Chiropractic service (manual spinal manipulations)

>

> This Medicare B News says " this applies to the following states :Alaska,

> Arizona, Hawaii, Nevada, Oregon and Washington. " They faxed this to me

when

> I asked them about billing issues.

>

> Anglen

>

March 9, 2001

, I agree about involving the patient in this process. I am drafting a letter currently to send to all the Medicare patients who have been in since I have owned the business (8 months) and to give to new ones. It has been there for 13 years and accepted Medicare assignment the whole time. In the first 6 months (when Aetna was our Medicare) I did not have a single visit denied. I am expecting my first payment March 15. If they have denied or audited most of the visits I am expecting payment on I will just have to walk away from my business and the lease as I will not be able to afford to continue in operation. The first electronic billing I sent in to Medicare in January was deleted by their error after acknowleding receipt of it. Although it was their mistake I had to resubmit it again, which is pushing our first possible payment this year from Medicare to March 15. When they make a clerical error they shrug, when we do it we go to jail.

March 9, 2001

It is my understanding that Medicare will not consider a hearing on any

specific case unless the bill in question is at least $100 or more. Each

denial I receive is followed up by a brief cover letter requesting a

review and copies of my chart notes. Sometimes I get pain, sometimes I

don't.

Some of my medicare patients will call their congressman whenever

medicare denies their claims, particularly when more than one visit is

involved. It seems medicare denies their claims less often. Each time

they contact their congressman he/she requests more info about the

troubles with medicare and the patients are only too happy to respond.

I also inform each patient of medicare's problems and the patient is

required to sign the explanation of medicare benefits form each visit.

They must understand with each visit the probability of medicare's

denial. The patient needs to get involved and fight for his/her benefits

as well. We cannot fight all their battles for them.

Holzapfel

Albany

March 9, 2001

At 09:13 AM 3/9/01 -0800, J Holzapfel DC wrote:

>. " Each denial I receive is followed up by a brief cover letter requesting a

>review and copies of my chart notes. Sometimes I get pain, sometimes I

>don't. "

Paid, or pain? A freudian slip, perhaps?

Les

March 9, 2001

, before you throw in the towel on your Medicare problems, give a

call to Terry and Penny over in Mesa. Terry helped to write the

rules currently being used in Medicare, and Penny manages a LARGE

Medicare practice, with mostly Medicare and Managed care Patients. Terry

is past president of the AZ. Association, and is a very caring and

wonderful Chiropractor. Thanks for your helpful participation in

Oregondcs. Ron Johansen DC 5032557746.

March 12, 2001

Les,

I just downloaded my email so sorry for the delayed response. I would be

happy to fax you a copy of my cover letter. What is your fax number? I

hope it helps...

April 26, 2002

Dr. Bob;

You are right on target, again! Reimbursement to a medical doctor

for therapeutic procedures that take the time a chiropractor takes to

examine and treat a patient typically receive from third party payers as

much as 10-20 times the dollars that a chiropractor receives for similar

time, effort, and skill. A good example is the one I posted about

my experience with a couple of dermatologists. Actually, it isn't a

very good example since I would be embarrassed to put our level of skill

and the thoroughness of our exams and documentation on the same level as

a dermatologist. We can't even bill accurately to MC. If I

see a new patient I have to use the 98940 code instead of the 99203, even

though I take a history and perform an exam that 98940 doesn't come close

to describing; yet 99203 brings no reimbursement at all. I think it

is time for our profession to get out of the back of the bus and take a

seat at the lunch counter.

S. Feinberg, D.C.

At 06:31 PM 4/25/02 -0700, W. Pfeiffer wrote:

LISTMATES;

UNHAPPY WITH MEDICARE ???????

MEDICARE DOUBLE

STANDARDS??????

Bulletin 196 Apr 15,

02 has the rules we MUST follow for E & M s on page

40. Time consuming aren t they????

Look on page

71 MC wants your

comments!

Everyone on this listserve should write to MC

and complain about the requirements they impose upon DCs, BUT

DO NOT re-imburse us for these services they request.

MC pays the other providers for E &

Ms but not DCs.

Uncle VERNE- Do you

think the ACA should advocate a letter writing campaign on this

subject?????

DrBob

W. Pfeiffer,

DC,DABCO

April 26, 2002

Good Luck guys,on turning around the Federal Bureaucracy and the AMA.Considering the opposition to just paying for the adjustment, can you imagine the screaming and yelling when we ask to be paid for xrays and exams. Perhaps the better option would be to just say no ,drop out and let the crying grannies who can't find an adjustment take the message to our Senators and Reps. I was looking at my overhead figures the other day and trying to figure why I do PART, chart notes, and all the other crap Medicare wants and then occassionaly get paid $25.66 when my cash senior non Medicare patients willingly pony up $29 all day long?!?. Dr , where is your secret formula for converting Medicare to Cash?Ron Johansen

On Fri, 26 Apr 2002 07:46:52 -0700 " S. Feinberg" <feinberg@...> writes:

Dr. Bob;You are right on target, again! Reimbursement to a medical doctor for therapeutic procedures that take the time a chiropractor takes to examine and treat a patient typically receive from third party payers as much as 10-20 times the dollars that a chiropractor receives for similar time, effort, and skill. A good example is the one I posted about my experience with a couple of dermatologists. Actually, it isn't a very good example since I would be embarrassed to put our level of skill and the thoroughness of our exams and documentation on the same level as a dermatologist. We can't even bill accurately to MC. If I see a new patient I have to use the 98940 code instead of the 99203, even though I take a history and perform an exam that 98940 doesn't come close to describing; yet 99203 brings no reimbursement at all. I think it is time for our profession to get out of the back of the bus and take a seat at the lunch counter. S. Feinberg, D.C.At 06:31 PM 4/25/02 -0700, W. Pfeiffer wrote:

LISTMATES; UNHAPPY WITH MEDICARE ??????? MEDICARE DOUBLE STANDARDS?????? Bulletin 196 Apr 15, 02 has the rules we MUST follow for E & M s on page 40. Time consuming aren t they???? Look on page 71 MC wants your comments! Everyone on this listserve should write to MC and complain about the requirements they impose upon DCs, BUT DO NOT re-imburse us for these services they request. MC pays the other providers for E & Ms but not DCs. Uncle VERNE- Do you think the ACA should advocate a letter writing campaign on this subject????? DrBob W. Pfeiffer, DC,DABCO

April 26, 2002

Listmates - My last response to Dr. Feinberg has been lost in chaos

somewhere. I'll try again....

Our exclusion from MC reimbursement for the other services we are

required to or may clinically choose to perform is not from the AMA

or HCFA. It is from the dichotomy of our profession. The

philosophical mess we have between those of us whom wish to practice

as Chiropractic Physicians and those Chiropractors that wish us not

to. If the ACA were the only significant national organization, we

would eventually have more parity. I believe the MC mess started when

we finaly entered into the program in the 1970's and the " subluxation

only " camp kept us at only treating " subluxations " and treating with

only adjustments instead of the plethora of adjunctive treatments we

use. Thus, we find ouselves here, responsible in this State (as well

as most others)for the patient's welfare by DDX and treatment but not

having any reimbursement for it. Indeed, prior to the change in CPT

coding a few years ago, our adjustment code did not require ANY

documentation,and we were reimbursed appropriately for that minimal

level of service. Now MC requires documentation, examination,

diagnosis but does not pay for it. We have the dichotomy to blame. If

you feel similarly, join the ACA.

P. Thille, D.C., FACO

Redmond, Oregon

-- In @y..., " S. Feinberg " <feinberg@e...> wrote:

> Dr. Bob;

>

> You are right on target, again! Reimbursement to a medical doctor

for

> therapeutic procedures that take the time a chiropractor takes to

examine

> and treat a patient typically receive from third party payers as

much as

> 10-20 times the dollars that a chiropractor receives for similar

time,

> effort, and skill. A good example is the one I posted about my

experience

> with a couple of dermatologists. Actually, it isn't a very good

example

> since I would be embarrassed to put our level of skill and the

thoroughness

> of our exams and documentation on the same level as a

dermatologist. We

> can't even bill accurately to MC. If I see a new patient I have to

use the

> 98940 code instead of the 99203, even though I take a history and

perform

> an exam that 98940 doesn't come close to describing; yet 99203

brings no

> reimbursement at all. I think it is time for our profession to get

out of

> the back of the bus and take a seat at the lunch counter.

>

> S. Feinberg, D.C.

>

> At 06:31 PM 4/25/02 -0700, W. Pfeiffer wrote:

>

> >LISTMATES;

> >

> >UNHAPPY WITH MEDICARE ???????

> >

> >MEDICARE DOUBLE STANDARDS??????

> >

> >Bulletin 196 Apr 15, 02 has the rules we MUST follow for E

& M s on

> >page 40. Time consuming aren t they????

> >

> >Look on page 71 MC wants your comments!

> >

> >Everyone on this listserve should write to MC and complain about

> >the requirements they impose upon DCs, BUT DO NOT re-imburse us

for

> >these services they request.

> >

> >MC pays the other providers for E & Ms but not DCs.

> >

> >Uncle VERNE- Do you think the ACA should advocate a letter

writing

> >campaign on this subject?????

> >

> >DrBob

> >

> > W. Pfeiffer, DC,DABCO

> >

April 28, 2002

:

Thanks for the ACA plug! The ACA currently has a bill in Washington DC that

will take care of this problem (Watkins bill) and two Oregon Congressmen are

co-sponsors of this proposed federal legislation that will reimburse us for

everything we do that is under our lic.

Vern Saboe, DC., FABS.,DACAN., FICC

Albany

Re: MEDICARE

> Listmates - My last response to Dr. Feinberg has been lost in chaos

> somewhere. I'll try again....

>

> Our exclusion from MC reimbursement for the other services we are

> required to or may clinically choose to perform is not from the AMA

> or HCFA. It is from the dichotomy of our profession. The

> philosophical mess we have between those of us whom wish to practice

> as Chiropractic Physicians and those Chiropractors that wish us not

> to. If the ACA were the only significant national organization, we

> would eventually have more parity. I believe the MC mess started when

> we finaly entered into the program in the 1970's and the " subluxation

> only " camp kept us at only treating " subluxations " and treating with

> only adjustments instead of the plethora of adjunctive treatments we

> use. Thus, we find ouselves here, responsible in this State (as well

> as most others)for the patient's welfare by DDX and treatment but not

> having any reimbursement for it. Indeed, prior to the change in CPT

> coding a few years ago, our adjustment code did not require ANY

> documentation,and we were reimbursed appropriately for that minimal

> level of service. Now MC requires documentation, examination,

> diagnosis but does not pay for it. We have the dichotomy to blame. If

> you feel similarly, join the ACA.

>

> P. Thille, D.C., FACO

> Redmond, Oregon

>

> -- In @y..., " S. Feinberg " <feinberg@e...> wrote:

> > Dr. Bob;

> >

> > You are right on target, again! Reimbursement to a medical doctor

> for

> > therapeutic procedures that take the time a chiropractor takes to

> examine

> > and treat a patient typically receive from third party payers as

> much as

> > 10-20 times the dollars that a chiropractor receives for similar

> time,

> > effort, and skill. A good example is the one I posted about my

> experience

> > with a couple of dermatologists. Actually, it isn't a very good

> example

> > since I would be embarrassed to put our level of skill and the

> thoroughness

> > of our exams and documentation on the same level as a

> dermatologist. We

> > can't even bill accurately to MC. If I see a new patient I have to

> use the

> > 98940 code instead of the 99203, even though I take a history and

> perform

> > an exam that 98940 doesn't come close to describing; yet 99203

> brings no

> > reimbursement at all. I think it is time for our profession to get

> out of

> > the back of the bus and take a seat at the lunch counter.

> >

> > S. Feinberg, D.C.

> >

> > At 06:31 PM 4/25/02 -0700, W. Pfeiffer wrote:

> >

> > >LISTMATES;

> > >

> > >UNHAPPY WITH MEDICARE ???????

> > >

> > >MEDICARE DOUBLE STANDARDS??????

> > >

> > >Bulletin 196 Apr 15, 02 has the rules we MUST follow for E

> & M s on

> > >page 40. Time consuming aren t they????

> > >

> > >Look on page 71 MC wants your comments!

> > >

> > >Everyone on this listserve should write to MC and complain about

> > >the requirements they impose upon DCs, BUT DO NOT re-imburse us

> for

> > >these services they request.

> > >

> > >MC pays the other providers for E & Ms but not DCs.

> > >

> > >Uncle VERNE- Do you think the ACA should advocate a letter

> writing

> > >campaign on this subject?????

> > >

> > >DrBob

> > >

> > > W. Pfeiffer, DC,DABCO

> > >

April 28, 2002

Dear Listmates,

Regardless of how,why and to whom we should blame for our current MC dilema,

I propose that we take a closer look at the legality of the current MC

policies: We are legally required to perform and document the initial

examination (extensive beyond the scope of examination time and content

provided for in the 9894x CMT code); yet we are legally not allowed to

receive renumeration for said service. If we were to " skip " the exam, we

would be subject to forfeiture of our license due to malpractice.

Therefore, it seems reasonable to me that an anti-trust case could (and

maybe should) be brought against the MC administrating agency.

allen

>From: " Vern Saboe DC " <las@...>

>< >, " mthille " <mpt@...>

>Subject: Re: Re: MEDICARE

>Date: Sun, 28 Apr 2002 13:08:04 -0700

>

>:

>

>Thanks for the ACA plug! The ACA currently has a bill in Washington DC

>that

>will take care of this problem (Watkins bill) and two Oregon Congressmen

>are

>co-sponsors of this proposed federal legislation that will reimburse us for

>everything we do that is under our lic.

>

>Vern Saboe, DC., FABS.,DACAN., FICC

>Albany

> Re: MEDICARE

>

> > Listmates - My last response to Dr. Feinberg has been lost in chaos

> > somewhere. I'll try again....

> >

> > Our exclusion from MC reimbursement for the other services we are

> > required to or may clinically choose to perform is not from the AMA

> > or HCFA. It is from the dichotomy of our profession. The

> > philosophical mess we have between those of us whom wish to practice

> > as Chiropractic Physicians and those Chiropractors that wish us not

> > to. If the ACA were the only significant national organization, we

> > would eventually have more parity. I believe the MC mess started when

> > we finaly entered into the program in the 1970's and the " subluxation

> > only " camp kept us at only treating " subluxations " and treating with

> > only adjustments instead of the plethora of adjunctive treatments we

> > use. Thus, we find ouselves here, responsible in this State (as well

> > as most others)for the patient's welfare by DDX and treatment but not

> > having any reimbursement for it. Indeed, prior to the change in CPT

> > coding a few years ago, our adjustment code did not require ANY

> > documentation,and we were reimbursed appropriately for that minimal

> > level of service. Now MC requires documentation, examination,

> > diagnosis but does not pay for it. We have the dichotomy to blame. If

> > you feel similarly, join the ACA.

> >

> > P. Thille, D.C., FACO

> > Redmond, Oregon

> >

> > -- In @y..., " S. Feinberg " <feinberg@e...> wrote:

> > > Dr. Bob;

> > >

> > > You are right on target, again! Reimbursement to a medical doctor

> > for

> > > therapeutic procedures that take the time a chiropractor takes to

> > examine

> > > and treat a patient typically receive from third party payers as

> > much as

> > > 10-20 times the dollars that a chiropractor receives for similar

> > time,

> > > effort, and skill. A good example is the one I posted about my

> > experience

> > > with a couple of dermatologists. Actually, it isn't a very good

> > example

> > > since I would be embarrassed to put our level of skill and the

> > thoroughness

> > > of our exams and documentation on the same level as a

> > dermatologist. We

> > > can't even bill accurately to MC. If I see a new patient I have to

> > use the

> > > 98940 code instead of the 99203, even though I take a history and

> > perform

> > > an exam that 98940 doesn't come close to describing; yet 99203

> > brings no

> > > reimbursement at all. I think it is time for our profession to get

> > out of

> > > the back of the bus and take a seat at the lunch counter.

> > >

> > > S. Feinberg, D.C.

> > >

> > > At 06:31 PM 4/25/02 -0700, W. Pfeiffer wrote:

> > >

> > > >LISTMATES;

> > > >

> > > >UNHAPPY WITH MEDICARE ???????

> > > >

> > > >MEDICARE DOUBLE STANDARDS??????

> > > >

> > > >Bulletin 196 Apr 15, 02 has the rules we MUST follow for E

> > & M s on

> > > >page 40. Time consuming aren t they????

> > > >

> > > >Look on page 71 MC wants your comments!

> > > >

> > > >Everyone on this listserve should write to MC and complain about

> > > >the requirements they impose upon DCs, BUT DO NOT re-imburse us

> > for

> > > >these services they request.

> > > >

> > > >MC pays the other providers for E & Ms but not DCs.

> > > >

> > > >Uncle VERNE- Do you think the ACA should advocate a letter

> > writing

> > > >campaign on this subject?????

> > > >

> > > >DrBob

> > > >

> > > > W. Pfeiffer, DC,DABCO

> > > >

April 28, 2002

After continuous trouble with rejections and request for chart notes

which never seem to go anywhere , I am looking at a business policy as

follows for new Medicare patients in my office:1) All NP will receive a

99202 coded exam for which they will personally be responsible,2) All NP

will meet Medicare xray requirements.If they don't bring one along, I

will take it and they will pay for it. 3 ) I f the NP has not met the

annual deductible, they pay cash in full until they have met it. After I

explained this policy last week to a prospective NP, they chose to not be

seen. IN my mind , if they dont want to spend $100 to begin the process,

I can't afford to have them as a patient. If they want socialized

Medicine, they can move to Canada. Am I getting cranky after my 55th BDAY

or what? Ron Johansen, Portland

On Sun, 28 Apr 2002 18:20:38 -0700 " Knecht "

<allenknecht@...> writes:

> Dear Listmates,

>

> Regardless of how,why and to whom we should blame for our current MC

> dilema,

> I propose that we take a closer look at the legality of the current

> MC

> policies: We are legally required to perform and document the

> initial

> examination (extensive beyond the scope of examination time and

> content

> provided for in the 9894x CMT code); yet we are legally not allowed

> to

> receive renumeration for said service. If we were to " skip " the

> exam, we

> would be subject to forfeiture of our license due to malpractice.

> Therefore, it seems reasonable to me that an anti-trust case could

> (and

> maybe should) be brought against the MC administrating agency.

>

> allen

>

> >From: " Vern Saboe DC " <las@...>

> >< >, " mthille " <mpt@...>

> >Subject: Re: Re: MEDICARE

> >Date: Sun, 28 Apr 2002 13:08:04 -0700

> >

> >:

> >

> >Thanks for the ACA plug! The ACA currently has a bill in

> Washington DC

> >that

> >will take care of this problem (Watkins bill) and two Oregon

> Congressmen

> >are

> >co-sponsors of this proposed federal legislation that will

> reimburse us for

> >everything we do that is under our lic.

> >

> >Vern Saboe, DC., FABS.,DACAN., FICC

> >Albany

> > Re: MEDICARE

> >

> > > Listmates - My last response to Dr. Feinberg has been lost in

> chaos

> > > somewhere. I'll try again....

> > >

> > > Our exclusion from MC reimbursement for the other services we

> are

> > > required to or may clinically choose to perform is not from the

> AMA

> > > or HCFA. It is from the dichotomy of our profession. The

> > > philosophical mess we have between those of us whom wish to

> practice

> > > as Chiropractic Physicians and those Chiropractors that wish us

> not

> > > to. If the ACA were the only significant national organization,

> we

> > > would eventually have more parity. I believe the MC mess started

> when

> > > we finaly entered into the program in the 1970's and the

> " subluxation

> > > only " camp kept us at only treating " subluxations " and treating

> with

> > > only adjustments instead of the plethora of adjunctive

> treatments we

> > > use. Thus, we find ouselves here, responsible in this State (as

> well

> > > as most others)for the patient's welfare by DDX and treatment

> but not

> > > having any reimbursement for it. Indeed, prior to the change in

> CPT

> > > coding a few years ago, our adjustment code did not require ANY

> > > documentation,and we were reimbursed appropriately for that

> minimal

> > > level of service. Now MC requires documentation, examination,

> > > diagnosis but does not pay for it. We have the dichotomy to

> blame. If

> > > you feel similarly, join the ACA.

> > >

> > > P. Thille, D.C., FACO

> > > Redmond, Oregon

> > >

> > > -- In @y..., " S. Feinberg " <feinberg@e...>

> wrote:

> > > > Dr. Bob;

> > > >

> > > > You are right on target, again! Reimbursement to a medical

> doctor

> > > for

> > > > therapeutic procedures that take the time a chiropractor takes

> to

> > > examine

> > > > and treat a patient typically receive from third party payers

> as

> > > much as

> > > > 10-20 times the dollars that a chiropractor receives for

> similar

> > > time,

> > > > effort, and skill. A good example is the one I posted about

> my

> > > experience

> > > > with a couple of dermatologists. Actually, it isn't a very

> good

> > > example

> > > > since I would be embarrassed to put our level of skill and

> the

> > > thoroughness

> > > > of our exams and documentation on the same level as a

> > > dermatologist. We

> > > > can't even bill accurately to MC. If I see a new patient I

> have to

> > > use the

> > > > 98940 code instead of the 99203, even though I take a history

> and

> > > perform

> > > > an exam that 98940 doesn't come close to describing; yet

> 99203

> > > brings no

> > > > reimbursement at all. I think it is time for our profession

> to get

> > > out of

> > > > the back of the bus and take a seat at the lunch counter.

> > > >

> > > > S. Feinberg, D.C.

> > > >

> > > > At 06:31 PM 4/25/02 -0700, W. Pfeiffer wrote:

> > > >

> > > > >LISTMATES;

> > > > >

> > > > >UNHAPPY WITH MEDICARE ???????

> > > > >

> > > > >MEDICARE DOUBLE STANDARDS??????

> > > > >

> > > > >Bulletin 196 Apr 15, 02 has the rules we MUST follow

> for E

> > > & M s on

> > > > >page 40. Time consuming aren t they????

> > > > >

> > > > >Look on page 71 MC wants your comments!

> > > > >

> > > > >Everyone on this listserve should write to MC and complain

> about

> > > > >the requirements they impose upon DCs, BUT DO NOT

> re-imburse us

> > > for

> > > > >these services they request.

> > > > >

> > > > >MC pays the other providers for E & Ms but not DCs.

> > > > >

> > > > >Uncle VERNE- Do you think the ACA should advocate a

> letter

> > > writing

> > > > >campaign on this subject?????

> > > > >

> > > > >DrBob

> > > > >

> > > > > W. Pfeiffer, DC,DABCO

> > > > >

April 28, 2002

Ron:

Buddy you have just instituted the office policy I have had for 21 years,

better late than later eh? Oh and did I mention that those folks that pay

for those services tend to want to buy one of everything else ya got to!

Vern Saboe

Re: MEDICARE

> > >

> > > > Listmates - My last response to Dr. Feinberg has been lost in

> > chaos

> > > > somewhere. I'll try again....

> > > >

> > > > Our exclusion from MC reimbursement for the other services we

> > are

> > > > required to or may clinically choose to perform is not from the

> > AMA

> > > > or HCFA. It is from the dichotomy of our profession. The

> > > > philosophical mess we have between those of us whom wish to

> > practice

> > > > as Chiropractic Physicians and those Chiropractors that wish us

> > not

> > > > to. If the ACA were the only significant national organization,

> > we

> > > > would eventually have more parity. I believe the MC mess started

> > when

> > > > we finaly entered into the program in the 1970's and the

> > " subluxation

> > > > only " camp kept us at only treating " subluxations " and treating

> > with

> > > > only adjustments instead of the plethora of adjunctive

> > treatments we

> > > > use. Thus, we find ouselves here, responsible in this State (as

> > well

> > > > as most others)for the patient's welfare by DDX and treatment

> > but not

> > > > having any reimbursement for it. Indeed, prior to the change in

> > CPT

> > > > coding a few years ago, our adjustment code did not require ANY

> > > > documentation,and we were reimbursed appropriately for that

> > minimal

> > > > level of service. Now MC requires documentation, examination,

> > > > diagnosis but does not pay for it. We have the dichotomy to

> > blame. If

> > > > you feel similarly, join the ACA.

> > > >

> > > > P. Thille, D.C., FACO

> > > > Redmond, Oregon

> > > >

> > > > -- In @y..., " S. Feinberg " <feinberg@e...>

> > wrote:

> > > > > Dr. Bob;

> > > > >

> > > > > You are right on target, again! Reimbursement to a medical

> > doctor

> > > > for

> > > > > therapeutic procedures that take the time a chiropractor takes

> > to

> > > > examine

> > > > > and treat a patient typically receive from third party payers

> > as

> > > > much as

> > > > > 10-20 times the dollars that a chiropractor receives for

> > similar

> > > > time,

> > > > > effort, and skill. A good example is the one I posted about

> > my

> > > > experience

> > > > > with a couple of dermatologists. Actually, it isn't a very

> > good

> > > > example

> > > > > since I would be embarrassed to put our level of skill and

> > the

> > > > thoroughness

> > > > > of our exams and documentation on the same level as a

> > > > dermatologist. We

> > > > > can't even bill accurately to MC. If I see a new patient I

> > have to

> > > > use the

> > > > > 98940 code instead of the 99203, even though I take a history

> > and

> > > > perform

> > > > > an exam that 98940 doesn't come close to describing; yet

> > 99203

> > > > brings no

> > > > > reimbursement at all. I think it is time for our profession

> > to get

> > > > out of

> > > > > the back of the bus and take a seat at the lunch counter.

> > > > >

> > > > > S. Feinberg, D.C.

> > > > >

> > > > > At 06:31 PM 4/25/02 -0700, W. Pfeiffer wrote:

> > > > >

> > > > > >LISTMATES;

> > > > > >

> > > > > >UNHAPPY WITH MEDICARE ???????

> > > > > >

> > > > > >MEDICARE DOUBLE STANDARDS??????

> > > > > >

> > > > > >Bulletin 196 Apr 15, 02 has the rules we MUST follow

> > for E

> > > > & M s on

> > > > > >page 40. Time consuming aren t they????

> > > > > >

> > > > > >Look on page 71 MC wants your comments!

> > > > > >

> > > > > >Everyone on this listserve should write to MC and complain

> > about

> > > > > >the requirements they impose upon DCs, BUT DO NOT

> > re-imburse us

> > > > for

> > > > > >these services they request.

> > > > > >

> > > > > >MC pays the other providers for E & Ms but not DCs.

> > > > > >

> > > > > >Uncle VERNE- Do you think the ACA should advocate a

> > letter

> > > > writing

> > > > > >campaign on this subject?????

> > > > > >

> > > > > >DrBob

> > > > > >

> > > > > > W. Pfeiffer, DC,DABCO

> > > > > >

April 29, 2002

Vern,

Did you say, " under our license? " Now that's a concept!!!!! Steve L.