ACA representatives met with representatives from the Center for Medicare and Medicaid Services (CMS) this morning regarding the incident to requirements. It was confirmed that due to the pending litigation against CMS by National Association of Athletic Trainers (http://www.nata.org/), all "incident to" requirements on DCs in the demo areas have been temporarily rescinded retroactive to April 1, the beginning of the demo. While we expect more information from CMS on how to file corrected claim forms in the near future, we wanted to make sure that the profession was aware of this vital information as soon as possible. It means that DCs participating in the demo are allowed to have their CAs perform "incident to" therapy services at this time. The ACA continues to raise its objection to the overall application of t incident to regulation to the demonstration project.

We have received advance copy of the CMS Q&A addressing this issue which will be posted on the CMS site (http://www.cms.hhs.gov/researchers/demos/eccs/default.asp) this upcoming Monday:

“Q: Can trained office staff who are not chiropractors, such as chiropractic assistants, provide therapy services “incident to” the chiropractor?
A: Due to pending litigation, CMS has agreed to delay implementation of the regulation and manual provisions governing qualifications for auxiliary personnel furnishing services billed as physical therapy and occupational therapy services incident to the services of a physician or nonphysician practitioner. We anticipate this delay to be temporary, probably less than two months. By its terms, CMS's agreement to delay implementation will expire on July 22, 2005, unless the court enters an injunction order prohibiting implementation of the qualification provisions described above. If the court rules in favor of CMS before July 22, 2005, CMS will issue instructions requiring implementation of the provisions of the regulation and manual. In light of CMS's agreement to delay implementing new Chapter 15 nual provisions and certain provisions of the regulations regarding “incident to” therapy services, chiropractic assistants, physical therapy assistants, or other trained office staff may provide therapy services incident to a chiropractor as of the beginning of the demonstration, April 1, 2005. Please note that the court has ordered that any hearing on the issue, if necessary, will take place on July 1, 2005. The incident to requirements for this demonstration will then mirror the court’s ruling regarding implementation of these manual provisions. If the court allows the CMS manual provisions to take effect, then chiropractors under the demonstration will also be subject to these requirements as of the effective date. This means that 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 lcnsure).”

The ACA will continue to update you as information becomes available. If you have any questions, please feel free to visit our demo website at www.acatoday.com/demo or call the ACA at 800-986-4636.

____________________________________________________________________________
We need you! If you aren’t a member of the ACA, please consider joining today by calling 1(800)986-INFO or visiting http://www.acatoday.com/pdf/MembershipApp2005.pdf. We do have a membership category for chiropractic assistants!

For additional information on the Medicare chiropractic demonstration project, please visit http://www.acatoday.com/demo.

The ACA Demo e-Alert is a online newsletter designed for doctors and billing staff practicing in the areas of the Medicare chiropractic demonstration project. This e-Alert will go out periodically to help individuals in these areas understand the regulations and billing procedures, as well as communicate the latest news from Centers for Medicare & Medicaid Services (CMS). ACA discusses details of the demonstration project regularly with CMS and other entities, and wants to ensure that the people on the frontline of this important initiative have access to all the information they need.