Re: Medicare-opting out and health freedom.

[Guest guest]

Dan and All:

Ques # 1 Where did this come from? Well...it kinda of came from me (originally).

Back in late 1990s early 2000s I was our (Chiropractor's in Oregon) CAC rep. to

Noridian. I diligently went to the quarterly meetings (god bless for

taking up this godforsaken role). I studiously learned all about the machine

known as medicare. Our office became perhaps the best and most knowledgeable

biller of medicare in the state. I spent lots of time on email and phone

answering dozens and dozens of questions from DC offices all over the state. We

were making money in medicare but spending a lot of time with it.

At some point I started to get frustrated. The begining was when they were

taking input for our LMRP back in about 2000-2001 or so. The LMRP is the " local

medical review policy " each specialty has one. I found out that the process was

a charade and that the LMRP was basically railroaded and really did not take in

any input from providers. I sent multiple letters on our behalf and they were

basically shuffled aside and the local Director (an MD who was a nice fellow)

basically said it was out of his power.

In this process, I also found out that our national trade association so-called

experts were really not that bright with respect to the subject of medicare.

They were more likely to MINDELESSLY echo the fear-mongerering and nonsensical

(and , as I found out later, Illegal) warnings of various medicare bureaucrats

and medicare-compliance-vendor-whackjobs.(These dopey vendors are the same

people who scared many DCs into buying those $2000 HIIPPA compliance kits,

remember them?) I also found out that lots of people (including DCs and their

CAs) actually seem to like being scared or having something to be scared about.

" Ohh you CAN'T do that " ... " You MUST comply " ... " or else " ....heh heh

And of course lots of folks make a living out of seminars that teach folks how

to comply with arcane gov't regulations of medicare (not so much in the chiro

field).

In 2000, I had a patient (let's say he is prolly in the Tea Party, nowadays) who

wanted NOTHING to do with the feds or medicare. I doubt the feds even knew this

guy existed...heh heh! I got a kick out of him. He was medicare-eligible but

wanted to pay cash. He insisted it was his right to not use medicare. I thought

about it and I said " sure " , but made him sign a little waiver, just in case.

What a pleasure it was to work with him. Cash on the barrelhead.

So I started making calls directly to medicare inquiring about a number of

things. One was the inability of DCs to opt out. Another was the patient's right

to " Not utilize " their medicare entitlement if they did not want to. I never got

anything in writing from CMS (back then they were called HCFA). But I DID get a

verbal confirmation from a mid-level dude...he said although it " was highly

unusual " that a benny would not want to use their wonderful medicare, it WAS

LEGAL to NOT USE IT I THEY DID NOT WANT TO.

It's like unemployment benefits, a person DOES NOT HAVE TO USE UNEMPLOYMENT

BENEFITS IF THEY DO NOT WANT TO.

Anyhow, within a few months, right after the tragedy of 9/11 there was this

little paragraph in the Part B News

http://bbnor.noridian.com/Bulletins/Medicare_Part_B/Medicare_B_News_Bulletins_an\

d_LMRPs-LCDs_%281994_to_Current%29/Medicare_B_News_Issue_192_Oct_2001/Chiropract\

ic-_Mandatory_Claim_Submission.htm

As I understand all the other carriers published similar blurbs, so obviously

the word came down from CMS to the carriers to publish this. Perhaps my calls

paid off...although there were one or two other DCS barking up the same tree

around the country. I like to think I had a lil somethin' to do with it.

I have had two attorneys " verbally " tell me that this is legal. Let's use our

brains for a second... THERE IS NO WAY you can send a claim form in if the

patient has not given you permission to do so. They must do so by signing line

12 of the claim form. Read line 12 on the CMS form..it has to be signed (or some

facsimile thereof). If they refuse to sign it, you are free. If they sign

something expressly forbidding you to submit claims, even better! This a really

a " no-brainer " but apprently most of us are " brain washed " . Think about

it....what if a pt. presents and simply states that they have no coverage (when

in fact they are a benny) and want to deal cash. You have no way of knowing that

they are , in fact, a benny.....you could treat them for years. They can not

suddenly say, oh BTW, I demand a refund for the last 5 years.....absolutely

bullshit. Well guess what, neither can the feds, if NO CLAIM FORM HAS BEEN

SIGNED.

One attorney was a guy I met in DC who worked with AAPS ( the association of

physicians and surgeons) he asked that his name not be used. BTW, this

organization has SOOOO much in common with we chiropractors, we Would join

forces with them if we had any marbles.

The other attorney was a guy who was a fellow Ron supporter who I discussed

this with in 2007. Both are involved in the growing area of " health Freedom " Let

me tell you guys, it has been hard to find attorneys who know anything about

this (for free). There was no money in the area of health-rights and

health-freedom in the past. But the area of health freedom is a GROWING field

(mostly due to vaccine injuries) and so more attorneys are getting into it. And

also, there is a revival in constitutional law going on too. There are numerous

non-profits dedicated to health freedom now.

Important, just remember. It is not the DC who is legally " opting out " . It is

the patient who is " opting out " .

Finally, IMPORTANT: the next DC (or CA) who emails me privately/off-the-list and

says " oohhhh you can't do that..I Went to seminar and they said you can't opt

out "

.....please do not expect a reply from me. I am going to put you on my spam list.

;-)

> >

> >

> > Christian,

> >

> >

> > Your message is right on. When outsider compare our documentation with the

> rest of the health professions, we come up SERIOUSLY lacking. To me, it

> seems that those audits are more for that reason than a skepticism that care

> isn't needed. Doing your work 'by the book' (or, as tho your harshest clinic

> observer is watching) is the best advice you could give the field. When our

> charting become more sophisticated, our detractors will have less to holler

> about.

> >

> >

> > Sunny

> >

> >

> >

> >

> > Sunny Kierstyn, RN DC

> > Fibromyalgia Care Center of Oregon

> > 2677 Willakenzie Road, 7C

> > Eugene, Oregon, 97401

> > 541- 654-0850; Fx; 541- 654-0834

> > www.drsunnykierstyn.com

> >

> >

> >

> >

> >

> > ----------------------------------------------------------

> > kjholzdc@;

> <mailto:%40> ; drscott@

> > From: cmathdc@

> > Date: Wed, 4 Aug 2010 08:45:37 -0700

> > Subject: Re: Medicare audits forcing chiropractors out?

> >

> >

> > ,

> > I've actually thought about your post overnight (something your posts

> don't generally require!) This is a major issue and one we will need to

> face.

> >

> > I believe part of the CERT program is to either eliminate Chiropractic

> from Medicare or scare us off. So your suggestion is exactly what the powers

> want of us -- to just go away.

> >

> > Instead, I think, if we're going to stay with the program and help some of

> our most favorite patients, we have to clean up our act and be ready for the

> audit. That means, do your chart notes as if your least favorite college

> instructor is grading you!

> >

> > Get your treatment plans and visit summaries and examinations up to date

> and exactly the way they want it. And when they send you a request for chart

> notes, be sure they are as beautiful as your Chiropractic style! For me,

> that means typing, since no one can read my handwritting.

> >

> > Yep, it's more work, but I think our patients are worth the struggle. And

> as Dr. Goodheart used to say, it's for the good of Chiropractic as well.

> >

> > Christian Mathisen, DC, CCWFN

> > 3654 S Pacific Hwy

> > Medford, OR 97501

> > cmathdc@

> >

> > Medicare audits forcing chiropractors out?

> >

> >

> >

> > Hi and colleagues,

> >

> > A friend of mine (out of state) was audited recently and has to give back

> a pile of money.

> > While appealing, they sent the bill to a federal collection agency with

> unlimited power.

> > She told them that the claim is in appeal and to hold off on trashing her

> credit, levying her bank account, or fining her....TO NO AVAIL.

> > She's since quit taking Medicare patients even though she's a great

> doctor.

> >

> > I have so many patients who have been with me for years who are now

> Medicare aged recipients that I hate to quit participating,

> > If this is a trend, however, from a risk-benefit perspective, it might be

> prudent to tell the elderly that we no longer take Medicare.

> >

> > Would it be prudent to encourage them to write their legislators about the

> heavy handed approach we are facing?

> >

> > E. Abrahamson, D.C.

> > Chiropractic physician

> > Lake Oswego Chiropractic Clinic

> > 315 Second Street

> > Lake Oswego, OR 97034

> > 503-635-6246

> > Website: http://www.lakeoswegochiro.com

> >

>