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Medicare
Demo Project Updates |
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March 29, 2005 From: American Chiropractic Association Re: Medicare Demonstration Project
We have just gotten off the phone with CMS concerning the demo. They have several requests for the state associations of the states involved in this project. On each association web site, there should be a link to the CMS Chiropractic Demo web page: http://www.cms.hhs.gov/researchers/demos/eccs/default.asp In addition, you may also
wish to link to the ACA Demo web page: Please make sure all demo information listed on your web site is up-to-date. The project starts Friday (April 1) and we need to make sure all posted information is current (e.g., listed counties for VA, IL, and IA). Please note there is a “more
organized” list of zip codes on the CMS web page than is given
in the Medlearn Matters article. This should prove useful for the states
of Virginia, Illinois, and Iowa. All doctors of chiropractic
need to decide whether or not they are going to participate in the demonstration
project (see clarification below). Providers will be responsible for
informing each and every Medicare patient of this decision—beneficiaries
need to be clear on which services will be reimbursable, and which will
not, before those services are rendered. Next week there will be Medicare
beneficiary fact sheets available. Please link these to your web sites
as well and encourage your demo area doctors to download them and distribute
them to their patients.
PLEASE NOTE: There has been further clarification from CMS in the project design—please make sure you get this clarification out ASAP!!!
For those providers wishing
to participate in the demonstration project (or not), it will be an
“all or nothing” situation—they will either be participating
in the project or they will not. They will NOT be able to
pick and choose which services are billed to the demo and which are
not! If a provider chooses to participate in the demonstration, they will be required to bill all covered services provided to the demo and, obviously, will need to abide by all relative rules. This is VERY important.
Again, doctors will not be allowed to submit some covered services to the demo and not submit others (with the obvious exception of spinal CMT). If the provider chooses to be part of the demonstration, and the service rendered is listed in Table 5 as a covered service, then the provider will be required to bill this service to Medicare.
Where this may become an issue is with the physical medicine services. As we all know, to provide physical medicine services to a Medicare beneficiary, the technician/therapist must be either a licensed physician (DC, MD, DO, DPM) or a graduate from one of the specified APTA or AMA programs. No one else may provide these services under the demo. Therefore, if a provider chooses to render physical medicine services, and is not willing to either provide the service themselves, employ a qualified person to do it, or refer the service out, then they will not be able to participate in this project. (Of course, as we know, providers not participating in the demonstration project may still treat Medicare beneficiaries and be reimbursed for active care spinal CMT services.)
If you have further questions, please contact Amy Hanley at the American Chiropractic Association. 1-800-986-4636 OR ahanley@amerchiro.org.
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