Medicare Resources for Chiropractors
Can Chiropractors Opt-Out of Medicare?
Chiropractors cannot opt-out of Medicare. We have 3 options when it comes to Medicare:
- Participate
- Non-Participating
- Not see Medicare patients in practice
Participate in Medicare
When you participate in Medicare, as a Chiropractor, you can see Medicare patients. After treatment you are required to bill their Medicare/insurance plan, then Medicare will pay you the allowed amount minus any copays, co-insurance, deductible. You will collect the remaining copay, co-insurance, and deductible from the patient. You cannot collect anything more than the allowed amount from Medicare.
Non-participating
When you choose not to participate with Medicare, as a Chiropractor, you are still required to bill the patients treatment to Medicare/insurance plan, however, the patient will pay you the full allowed amount for the service. Then Medicare/insurance will reimburse the patient. You cannot collect anything more than the allowed amount from Medicare for the non-participating fee schedule in your area.
Not see Medicare Patients in Practice
If you have not enrolled in Medicare as a participating or non-participating provider then you should not see Medicare patients in your practice.
Medicare Provider/Supplier Enrollment Applications
The Medicare enrollment application (CMS-855 or Internet-based Provider Enrollment, Chain and Ownership System (PECOS)) is an Office of Management and Budget approved form and is available in PDF fillable format. This format allows a user to complete an application using Adobe Acrobat and save this information on their personal computer or download the application. To access the applications, please refer to the CMS Forms List link below.
CMS Forms
- CMS-855B Medicare Enrollment Application for Clinics & Group Practices
- CMS-855I Medicare Enrollment Application for Physicians and Non Physician Practitioners
- CMS-855R Medicare Enrollment Application for Reassignment of Medicare Benefits
The following forms are routinely submitted with an enrollment application:
- Electronic Funds Transfer (EFT) Authorization Agreement (Form CMS-588)
- Medicare Participating Physician or Supplier Agreement (Form CMS-460)
SUBMITTING AN APPLICATION:
Medicare enrollment application forms are fillable on your computer. This means that you can fill out the information required by typing into the open fields while the form is displayed on your computer monitor. Filling out the forms this way before printing, signing and mailing means more easily-readable information – which means fewer mistakes, questions, and delays when your application is processed. Be sure to make a copy of the signed form for your records before mailing. Signatures are still required to be handwritten. Don't forget to complete this important step prior to mailing your typed form(s).
Keep in mind that typed forms are easier for Medicare to process, but the most efficient method for submitting your enrollment application is to use the Internet –Based Provider Enrollment, Chain and Ownership System (PECOS). PECOS guides you through the enrollment application so you only supply information relevant to your application. PECOS also reduces the need for follow-up because of incomplete applications. Using Internet-based PECOS results in a more accurate application and saves you time and administrative costs. Click on the Internet- Based PECOS tab on the left to learn more.
Mail your completed application and all supporting documentation to the Medicare fee-for-service contractor (also referred to as a carrier, fiscal intermediary, Medicare Administrative Contractor, or the National Supplier Clearinghouse) serving your State or geographic location. To find the Medicare fee-for-service contractor serving your State or geographic location, please return to the "Overview" section of this web site and select the first download titled, "Medicare Fee-For-Service Contact Information." To avoid delays in application processing, do not mail your application to the Centers for Medicare & Medicaid Services in Baltimore, Maryland.
Mailing List
Note: If you are enrolled in Medicare, but have not submitted a CMS-855 since 2003, you are required to submit a complete application. Providers and suppliers should follow the instructions for completing an initial enrollment application.
By submitting a Medicare enrollment application, a physician provider or other supplier will establish an enrollment record in PECOS. For physicians and eligible non-physician practitioners, this means that your name and National Provider Identifier will be added to the Ordering and Referring Report during the next update cycle.
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