Advocacy - Chiropractic Medicare Demonstration Project {Please read - good stuff}

[Guest guest]

This email was supposed to be my first advocacy post

but didn't send for some reason.

Im sure most of you know of the Chiropractic Medicare

Demonstration Project. If you are not aware, reference

it on the ACA's website. A brief description:

" November 24th, 2003 - President Bush authorized a

two-year pilot project designed to test expanded

access to chiropractic services for America's

seniors. " This project basically allowed chiropractors

in some states to bill for physical therapy services

and other medical care beyond the only service covered

by Medicare - manipulation to correct a subluxation.

Their point is that expanding Chiropractic care

coverage improves patient access and is in the best

interest of Medicare beneficiaries. Let's see how much

chiro's care about patients' best interests...

Look at the attached file. This is the Q & A page on the

ACA website regarding incident to billing. Read the

highlighted area. A chiro asks the ACA if he can bill

for physical therapy services if provided by a

chiropractic assistant (which has no more formal

training than a PT aide). Already, in their own

" Demonstration Project " they are delegating services

to unqualified personnel. The ACA basically responds

by saying YES. The ACA proceeds to purposely

misrepresent the context CMS's rule and tells the

chiro to use an NEMB form then change modifiers in

billing to purposely get a denial, then bill the

patient directly! Does not seem to have the clients

interest in mind. I emailed the ACA questioning their

use " concern for patient's interests " pointing out the

Q & A post on their site and let them know I forwarded

the e-mail to Medicare. Below is what the ACA's Q & A

section for the Demonstration Project looks like now

regarding that question. They changed the chiro's

question and their answer:

Incident to Requirements

Q. Can trained office staff who are not chiropractors,

such as chiropractic assistants, assist the

chiropractor in providing therapy services? For

example, can a chiropractic assistant or other trained

office staff place electrodes on a patient and have

the chiropractor verify placement and start the

machine, or is it necessary for the chiropractor to do

the entire procedure him/herself?

A: " Chiropractors must follow the 'incident to'

requirements for therapy services as described in the

physician regulation. When a physical therapy service

is provided 'incident to' the service of a

chiropractor, the person who furnishes the service

must be a physical therapy qualified practitioner

other than licensure (meeting the physical therapy

definition at 42 CFR 484.4 - other than licensure).

Chiropractors cannot split a therapy service and have

a staff person perform part of it if that person does

not meet the qualifications described in the

regulations. "

Use this link if you want to read more

http://www.acatoday.com/demo/faq/

The project is to be reviewed in 2008. We need point

out faults like this with chiro's wanting to use

completely unqualified personnel and bill incident to

for PT.

Bisesi MPT COMT

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