Chiropractic Coding & Compliance Alert

Published on Fri Feb 13, 2015 PDF

Question: Can chiropractors opt out of Medicare?

California Subscriber

Answer: No. Opting out of Medicare is not an option for Doctors of Chiropractic. Being non-participating and opting out are not the same things.

Non participating provider: A health care provider who chooses not to participate in the Medicare program is referred to as a “nonparticipating provider.” This provider does not accept Medicare’s assignment. A patient who receives services from a such a health care provider who does not accept assignment from Medicare, may be required to pay the full amount of the service at the time of delivery. The full amount or charge cannot exceed the “limiting charge”.

“Opting out”: When a physician/practitioner opts out of Medicare, Medicare covers no services provided by that individual and no Medicare payment can be made to that physician or practitioner directly or on a capitated basis. Additionally, no Medicare payment may be made to a beneficiary for items or services provided directly by a physician or practitioner who has opted out of the program.

Chiropractors may decide to be participating or non-participating with regard to Medicare, but they may not opt out. For further discussions of the Medicare “opt out” provision, see the Medicare Benefit Policy Manual (Chapter 15, Section 40; Definition of Physician/ Practitioner) at http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/bp102c15.pdf.