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.