Recently, I spent an afternoon with a client, a licensed chiropractor, in front of his state board of examiners regarding a complaint from a Medicare patient. This was an interesting meeting for me, as I have spent the better part of the last 20 years begging chiropractors to pay attention to the significant requirements that CMS puts on our profession.
The client did nothing malicious. He did what most chiropractors do when a Medicare patient asks about an exam or a therapy: he offered it as a courtesy. That courtesy was the reason we were in front of the board.
Start with the definition
CMS classifies chiropractic services into two buckets. Spinal manipulation for the treatment of a subluxation is a covered service. Everything else a chiropractor typically provides — exams, re-exams, therapies, x-rays, orthotics, supplements — is an excluded service. ‘Excluded’ does not mean ‘optional to bill.’ It means the patient is fully responsible, and that responsibility must be documented before the service is rendered.
Three rules that protect your license
First, please make sure your Medicare patients plainly know that they are fully responsible for excluded services — exams, therapies, x-rays. This one issue alone can cause a Medicare patient to call the board, and as we all probably understand, any complaint must be totally and completely investigated. Written disclosure at the first visit is not a suggestion. It is your paper trail.
Second, if you have just one fee schedule that everyone gets billed, make certain that your Medicare patients understand they will get a write off due to ‘contractual obligation’ as stated on the EOB. The write-off is a clerical adjustment, not a free service. Explain the distinction before it shows up on a statement.
Third, issue an Advance Beneficiary Notice (ABN) any time you think Medicare might deny a service. The ABN is the only document that lets you bill the patient directly when Medicare refuses payment. No ABN, no collection.
Federal law wins
This is the part most chiropractors get wrong. Federal law prohibiting inducements supersedes state board authority. Offering free services to Medicare beneficiaries violates CMS policy regardless of state regulations. Your state board cannot authorize what CMS forbids. If a state rule tells you something CMS tells you is illegal, follow CMS.
Use the tools you already have
Platinum’s Insurance Billing module flags excluded services automatically. The moment a Medicare patient is scheduled for an exam, a therapy, or an x-ray, the system prompts the front desk to collect the ABN. The patient ledger tracks contractual write-offs separately from voluntary discounts, so your year-end reports show the difference clearly. Clean claims start at the front desk, not at the claim scrubber.
The afternoon I wish nobody had to spend
The client I started this article with kept his license. The process cost him several thousand dollars in legal fees, countless hours of stress, and a reputation hit in his community that took a year to recover from. All of it was preventable. Medicare compliance is not a paperwork problem. It is a workflow problem, and if your software does not help you solve it, you are solving it with your career as collateral.