06/24/2025
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“Met with a DO this week that had in his paperwork that he was not opted into Medicare.
How frustrating and unfair is it that they can opt out but we can't?!
Is there anything we are doing as a profession at the political level to get this changed? I feel that it is a detriment to all the Medicare patients out there that can't choose chiros that choose not to do Medicare. It's like there are medically kidnapped almost. Their choice to the professional of their choosing is so limited because so many of us choose not to even touch a Medicare patient than to be par/nonpar”
Chiropractors cannot opt out of Medicare, but they can choose to be participating (Par) or non-participating (Non-Par) providers. Participating providers accept Medicare's approved amounts as full payment, while non-participating providers may charge up to 15% more. Regardless of their status, chiropractors must still file claims for covered services with Medicare.
Here's a more detailed explanation:
1. Opting Out vs. Participating/Non-Participating:
Opting Out:
Chiropractors are not permitted to opt out of Medicare, meaning they cannot completely exclude themselves from the program and treat patients without regard to Medicare rules.
Participating (Par):
Participating providers agree to accept Medicare's approved amount as full payment for covered services and have their claims automatically processed by Medicare.
Non-Participating (Non-Par):
Non-participating providers may choose to accept assignment (meaning they accept Medicare's approved amount as full payment) on a claim-by-claim basis or not. If they don't accept assignment, they can charge up to 15% more than the Medicare-approved amount for covered services.
2. Billing Requirements:
Required Billing:
Regardless of whether a chiropractor is Par or Non-Par, they are required to file claims with Medicare for all covered services provided to Medicare beneficiaries.
Claim Submission:
This means that a chiropractor cannot simply choose to be a "cash-only" practice for Medicare patients.
Exceptions:
The only exception is if a beneficiary or their legal representative refuses, of their own free will, to authorize the submission of a bill to Medicare
Chiropractors cannot opt out of Medicare, but they can choose to be participating (Par) or non-participating (Non-Par) providers. Participating providers accept Medicare's approved amounts as full payment, while non-participating providers may charge up to 15% more. Regardless of their status, chiropractors must still file claims for covered services with Medicare.
Here's a more detailed explanation:
1. Opting Out vs. Participating/Non-Participating:
Opting Out:
Chiropractors are not permitted to opt out of Medicare, meaning they cannot completely exclude themselves from the program and treat patients without regard to Medicare rules.
Participating (Par):
Participating providers agree to accept Medicare's approved amount as full payment for covered services and have their claims automatically processed by Medicare.
Non-Participating (Non-Par):
Non-participating providers may choose to accept assignment (meaning they accept Medicare's approved amount as full payment) on a claim-by-claim basis or not. If they don't accept assignment, they can charge up to 15% more than the Medicare-approved amount for covered services.
2. Billing Requirements:
Required Billing:
Regardless of whether a chiropractor is Par or Non-Par, they are required to file claims with Medicare for all covered services provided to Medicare beneficiaries.
Claim Submission:
This means that a chiropractor cannot simply choose to be a "cash-only" practice for Medicare patients.
Exceptions:
The only exception is if a beneficiary or their legal representative refuses, of their own free will, to authorize the submission of a bill to Medicare.
3. Key Differences and Considerations:
Payment:
Participating providers are paid directly by Medicare, while non-participating providers may have a choice to receive payment directly from Medicare or from the patient (if they choose not to accept assignment).
Patient Choice:
Non-participating providers must inform patients of their status and payment options, so patients can make informed decisions about where to seek care.
Deductibles and Coinsurance:
Medicare patients are still responsible for their deductibles and coinsurance, regardless of whether their chiropractor is Par or Non-Par.
In summary: Chiropractors have the choice of being participating or non-participating with Medicare, but they cannot opt out entirely. They must still file claims for covered services and are subject to Medicare regulations.
