Non-participating does NOT mean non-participating
Recently I was told by several doctors that they do not participate with Medicare. Since they do not participate with Medicare, they charge their normal fee for Medicare spinal manipulation and collect cash. This is not only illegal, it will probably result in huge fines for these doctors.
Before you see a Medicare patient, you must first enroll with Medicare.
This is accomplished with the 855i Enrollment application that can be downloaded from the Medicare website. Upon filling out the form, you must then choose whether you wish to be a participating or a non-participating physician.
Participating Physician means that you bill Medicare for the service and they reimburse the doctor directly. Medicare also pays you a 5% increase in fees over the non-physician rate. Medicare will forward the claim to the Medigap insurance for the secondary payment. As a Participating (PAR) physician, you are also listed in the Medicare Participating Physician Directory, which is provided to each Medicare patient.
A Non-Participating Physician (Non-Par) means that you still must file the claim with Medicare for the patient, who then is reimbursed by Medicare. In this case, Medicare reimburses the patient directly. Medicare reimburses at a lower rate than the par rate, but the doctor can charge up to the limiting charge. If the doctor charges anything over the Limiting charge, you will be fined $10,000 per occurrence (per claim)!
Under NO circumstances can a chiropractor not bill Medicare for spinal manipulation that is medically necessary (i.e. not maintenance care). IT IS ILLEGAL FOR A CHIROPRACTOR TO OPT OUT OF MEDICARE. An M.D. or a D.O. can opt out of Medicare, but it is illegal for a D.C. to opt out of Medicare.
If you do not wish to bill Medicare or in anyway participate with Medicare, then you cannot see a Medicare patient.
The bottom line is this: if you see a Medicare patient, you must file a claim for them. here is no opting out of Medicare and there is no such thing as a pure "cash" practice when it comes to a Medicare patient.
Add this blog to 
Chiropractic Doctors can decide NOT TO SEE MEDICARE PATIENTS AT ALL.... this is a choice the provider can make, not Medicare.
But if the doctor is seeing Medicare beneficiaries then they are required to enroll with Medicare and file a claim within 12 months for all covered services and non-covered services upon request.
Posted by: thoughts on the topic | April 20, 2010 at 06:42 AM
Medicare reimburses at a lower rate than the par rate, but the doctor can charge up to the limiting charge. If the doctor charges anything over the Limiting charge, you will be fined $10,000 per occurrence (per claim)!
Posted by: James Morgan - Puritan Financial Advisor | September 09, 2010 at 04:07 AM
I've heard lot of this also. I agree with your statement.
Posted by: Seattle Chiropractor | February 17, 2011 at 09:55 AM
Medicare will forward the claim to the Medigap insurance for the secondary payment.
Posted by: ClubPenguinCheats | March 31, 2011 at 03:35 AM
The electronic forwarding of a claim (crossover) is done by the carrier only for the Participating provider. This is beneficial especially for the patient. That is why whether you are par or non-par, continues to be a practice business decision.
Posted by: Mario Fucinari DC | March 31, 2011 at 06:36 AM
"... IT IS ILLEGAL FOR A CHIROPRACTOR TO OPT OUT OF MEDICARE. An M.D. or a D.O. can opt out of Medicare, but it is illegal for a D.C. to opt out of Medicare. ..."
Anyone or any organization ever think about suing under the "equal protection" clause? Seems obvious from a non-legal scholar's point of view. Of course we'd lose because the Feds make the rules and are incentivized to not pay.
Posted by: CalIDC | September 01, 2011 at 01:29 PM