DC's Refund Money To Medicare

[Michele]

Many chiropractors provide Foot Levelers to their patients.  Read our blog post about DMERC (Medicare) requesting money back for any Foot Levelers provided to Medicare patient's paid in the last 3 years.

Read more on our blog:

http://solutionsmedicalbilling.wordpress.com/

Please comment if you have any knowledge, experience, or thoughts!

Personally I think that  Medicare is trying to find ways to make cuts without doing it thru the lawmakers.

[DMK]

Medicare ONLY pays chiropractors for adjusting the spine.  You don't get paid for adjusting extremities, providing therapies, modalities, supplies, supports or supplements.  You don't even get paid for the exam, but you have to do it!  You USED to be able to order an x-ray, you can't anymore.  They have to go to their family doctor and have them order it. 

Any chiropractor who received payment for anything other than adjusting the spine SHOULD have to pay the money back to Medicare.  It was NEVER covered, even if they were referred by their MD.  He or she should not have been surprised.

It's messed up since chiropractic is inexpensive, but that's the way it's been for at least the last 11 years.  And we are grateful that they've included chiropractic in Medicare part B, we're really hoping they don't carve it back out to "save" money!

[PMRNC]

I DO NOT DEAL WITH CHIROPRACTORS...  HOWEVER..  they have a right to request money back when an error has been made. Like DMK said..they knew it, just because medicare paid in error shouldn't mean it's payable nor set a precedence in this instance. There are specific guidelines carriers have to follow in order for a processing "error" to become a precedence.

[Michele]

He's not arguing that they made a mistake.  He's actually upset because prior to enrolling to become a Medicare supplier (which is different than billing for the manipulations) his staff made several phone calls to Medicare DME to inquire about coverage for the inserts and his ability to provide them.  In all calls he was never advised that the inserts had to be prescribed by another dr.  Then he went thru the lengthy enrollment process.  Chiros can provide supplies to patients (tens units, pillows, etc) and get reimbursed, BUT what Medicare is now saying for the reason that they are requesting the money back is that the DC cannot prescribe the supplies.  So if a Dr ordered a tens unit, or inserts, or pillow, then the patient could get that item from a chiropractor who is enrolled with Medicare to be a supplier.  Basically, it doesn't matter that the guy is a DC, he's basically any guy off the street who qualifies as a supplier since they require that an actual MD or DO prescribe.  However, his complaint is that he tried to make sure he was compliant, submitted the claims showing he was the ordering physician, and then 3 yrs later is told "no".

I didn't say I don't understand or that I disagree with Medicare ~ I agree when money is paid in error it don't make a difference.  I'm just saying that the guy did try to do all correct.

[PMRNC]

I didn't say I don't understand or that I disagree with Medicare ~ I agree when money is paid in error it don't make a difference.  I'm just saying that the guy did try to do all correct.

Yes, i see what you are saying.  Guess he's not going to be happy with the ol "Shit happens" reasoning? LOL   I'm just kidding.. that has to be frustrating. I have had provider's get requests for refund's after a year or so due to coverage being rescinded, which can't be fought either, then we have to chase down the patient's.

[DMK]

I completely agree that if he was AUTHORIZED to provide the supplies it shouldn't be an issue. It's completely frustrating when they, Medicare, leaves out that important piece of information "Oh, by the way, all these years later, you can't prescribe the stuff you can only provide it. 

I sure hope there's not an audit for fraudulent billing!