Medicare Patients Eligible To Join PCD

As you know, Medicare patients were not eligible to participate in the PCD program because of Federal Regulations that required providers to complete a claim form on all Medicare patients for approved services. We believed it was in the best interest of the PCD Provider and PCD not to flirt with the Federal Government so we excluded Medicare patients from eligibility in the PCD Program.

After numerous letters and telephone conversations with Medicare Administrators, attorneys and politicians we finally have an answer to the Medicare dilemma at PCD.

In a letter dated 12-28-98 from the Department of Health and Human Services in Baltimore, Maryland, our solution found it’s way to PCD by way of U.S. Senator Richard Shelby, who had inquired on behalf of PCD.

I quote the relative portion: "A chiropractor may provide services to a Medicare beneficiary without having to submit a claim to Medicare in two situations:

-The service is not covered by Medicare for reasons other than the absence of medical necessity. For example, the only professional service that is covered by Medicare is chiropractic manipulation for a subluxation of the spine. If a chiropractor provides a professional service other than this service, it is outside of the scope of the Medicare benefit and cannot be covered. The chiropractor does not need to submit a claim to Medicare and may bill the beneficiary for such a non-covered service without regard to the Medicare limiting charge; or

-The service is covered by Medicare but the beneficiary refuses to authorize  the chiropractor to submit the claim to Medicare. In this case, the chiropractor may not charge the beneficiary more than the Medicare limiting charge for the covered service, notwithstanding that no claim is submitted to Medicare."

While we have been aware of both of these situations, the various sources that had responded to our previous request would tend to contradict each other. We were not comfortable exposing PCD providers to unknown liability. With this clarification from HCFA we feel secure in opening up the PCD program to Medicare Beneficiaries.

There will be one primary requirement you must meet in order to allow Medicare beneficiaries to join PCD. The Medicare beneficiary must refuse to authorize you to submit his/her Medicare claim. We have created a "PCD Medicare Repair Kit" which includes simple instructions and an example "Refusal Form" that you can use until new materials are printed and distributed to Providers. You can obtain a copy by e-mail, fax or snail mail. Simply contact us by phone, fax or e-mail and we will get your "Repair Kit" out to you immediately. To obtain the "Repair Kit" you must contact us.

Preferred Chiropractic Doctor  Medicare Repair Kit Instructions

These instructions will illustrate the proper way to include Medicare Patients in the Preferred Chiropractic Doctor Program.

Prior to offering membership to any Medicare beneficiary it is imperative that you read, understand and abide by the simple steps included in the "repair kit."

Quick Reference Guide

1. Complete refusal form.

2. Complete PCD application.

3. Process as usual.

STEP BY STEP INSTRUCTIONS

STEP ONE: Refusal Form

To comply with Medicare it is important to have the beneficiary complete, understand and sign the Refusal Form. You may make copies of the enclosed example or edit the example to suit your needs. Do not modify the language of the enclosed example.

STEP TWO: Application

Have the Medicare Applicant complete the Consumer Application and Terms of Agreement just as any other consumer would.

STEP THREE: Process as Normal

Congratulations! You now have another committed patient and have created a value added experience for this new patient.

NOTE:

The Medicare Beneficiary will still be able to utilize his or her Medicare benefits if they choose to do so but, they cannot use Medicare and PCD at the same time pursuant to the terms of agreement on the PCD Consumer Application.

Will joining PCD have any affect on my Medicare Benefits?

answer: NO. You determine when you want to use your benefits and when you do not want to use your benefits. At the time you wish to utilize your Medicare Benefits simply inform the front desk of your decision.

Can I use my Medicare Benefits until they are exhausted and then use the PCD program to enjoy more affordable fees?

answer: YES. It is entirely your decision when you want to use your Medicare Benefits and all you have to do is inform the front desk that you want to use your Medicare insurance.

Why can’t you give me a discount without joining the PCD Program?

answer: You may not be aware of the hidden costs involved in processing insurance claim forms. The discounted fee I offer PCD members represents not only a savings in my costs, which I am glad to pass on to you, but the PCD Program also offers other benefits to it’s members, such as the educational Newsletter sent to you as a benefit of PCD membership.
If you have any other specific questions, comments or observations regarding Medicare and PCD please contact our office...That’s why we’re here. We hope that this new dimension of PCD will be of benefit to your patients and your practice.

Preferred Chiropractic Doctor Medicare Membership Refusal Form

I understand that the processing of insurance claim forms requires additional expense for my provider and increases the cost of services provided by my provider. In order that I may become eligible to participate in the Preferred Chiropractic Doctor discount program I am refusing to authorize my provider to file claims with Medicare effective __________________, until _________________.

Patient Signature: _______________________________________

Print Name: _______________________________________

Date: __________________________________

This form complies with Medicare regulations which require that Medicare beneficiaries who do not wish their provider to submit a claim to Medicare must refuse to authorize their provider to submit such claims.