ALERT! Major Medicare DME Change
As of January 1, 2021, Medicare DME will implement the Competitive Bid Program for a category of Medicare DME that includes various supplies such as lumbar braces and knee braces. For those Chiropractors currently involved and certified to bill Medicare DME, the program will undergo a major and significant change that will, in all probability, end the program for those chiropractors who currently enjoy Medicare DME PTAN certification.
Let me explain. The Competitive Bid status will begin on January 1, 2021. All current suppliers will have an opportunity to bid to become a supplier for their geographical area sometime in 2020. After extensive investigation from numerous reliable sources, it is my opinion that an office wholly owned by Chiropractors that are now certified to participate in supplying products and billing Medicare DME will not be able to be accepted as a “winner” in the competitive bidding process. Chiropractic offices are just not substantial enough in their business to handle the volume of demand a selected DME supplier will have to be able to handle for a geographical area. While you can bid a lower fee, that is not as important as compared to your ability to handle a large volume in your area. That is the bad news.
There is good news. Those Chiropractic certified suppliers who have a MD, DO, PA, or Nurse Practitioner as a 5% or greater owner of that practice and that practice is listed as a medically (physician) exempt certified supplier will continue as exempt from the Competitive Bid process and will continue to enjoy the privilege of being able to supply, bill for, and to be reimbursed at the approved values on their patients. You may contact me directly for more specific information concerning the exempt status entity.
Let me repeat this exemption. Physician practices will be exempt from the Competitive Bid process. The physician exemption applies to medical physicians, osteopathic physicians, physician assistants, and nurse practitioners. Chiropractors are not considered physicians that are exempt under Medicare DME rulings. This attitude and treatment of Chiropractors first started in 2012 when Chiropractors had to undergo the accreditation process on their facilities before being able to apply for Medicare DME certification. Before 2012 Chiropractors were treated as physicians with limited status.
So: If the practice is integrated and has an exempt status owner of at least 5% of the practice, that practice will be considered exempt. The business will go on as before. For those practices that are integrated but the exempt persons are employees, that practice will not be exempt and that practice’s ability to supply, bill, and be reimbursed will end.
In my world of consulting on this issue, over 50% of those practices I have helped are already integrated and I now believe have no need to be concerned. It would be wise, however, to double check your status. The real concern exists for those Chiropractic owned practices that do not have a 5% or greater ownership by one of the exempt status persons. For those practices in jeopardy of losing their ability to participate in Medicare DME they will have four options:
- Do nothing and wait and see what happens.
- Remain the same and try to participate (win) in the Competitive Bid process.
- Rearrange the ownership to include at least 5% of the exempt professional category persons and clarify that status with Medicare DME.
- Be aware that their status will end on January 1, 2021, and resign themselves to that fact.
Why is this change occurring you might ask? What did chiropractors do wrong for this to happen to them? The following is my opinion and I have no real data or sources to quote you. The following is strictly based on my experience over many years in this field of health care and the “back alley” sources that I have developed relationships with over the years.
Chiropractors, when they accepted their status in Medicare back in the 1970s as being able to only be reimbursed for Chiropractic adjustments sealed their fate. While a consultation, an examination, x-rays, and any other appropriate actions must be performed and documented at length, only the adjustment would be reimbursed. Today we now live with the fact that Chiropractic is significantly impacted in performing health care to Medicare enrollees, which are a large and growing segment of the population in the United States. This status now leaves Chiropractors out of the loop in the physician exemption certification concerning Competitive Bidding in Medicare DME.
Recently a large FBI police action arrested many individuals involved in criminal activity concerning the Medicare DME reimbursement of DME supplies such as lumbar braces and knee braces. You may have seen their adds on television. I have been advising my clients for years to stay away from these people and their business promises of lead generation. This criminal activity hurt those certified in a similar category and lead to, I believe, a “throwing out the baby with the bathwater”.
This article serves to inform you of the upcoming changes. It has always been my philosophy that the only way to make real and meaningful decisions to have the most accurate information that one can. Chiropractors have always been participating in the health care arena as helping sick and injured people get well and helping good people stay well. Chiropractic can even succeed in “supercharging” their patient’s health, well-being, performance, and enjoyment of a great quality of life. While this upcoming change will be a challenge for many participating Chiropractic offices, it can also be a real change to modify their business model to be able to highly succeed in the future.
James C. Antos D.C., DABCO
Antos & Associates, LLC
Web site: AntosDMEbrace.com
Email: [email protected]
Telephone and text: 386-212-0007