Effective September 1st, 2011, providers and suppliers who furnished items or services to Medicare beneficiaries as a result of an order or referral from a chiropractor will NOT be reimbursed by Medicare.
The Centers for Medicare & Medicaid Services (“CMS”) issued Transmittal 386 which removed chiropractors from the list of providers who can order and/or refer Medicare services.
Section 1833(q) of the Social Security Act requires that all ordering and/or referring physicians and non-physician practitioners must be uniquely identified on all claims for items or services that are the result of orders or referrals. Essentially, claims that are the result of an order or a referral must contain the National Provider Identifier (“NPI”) and the name of the ordering/referring provider.
When Medicare receives a claim for reimbursement it will determine whether the ordering/referring provider is eligible to order or refer items or services. If the ordering/referring provider is NOT eligible to order or refer items or services, then Medicare will NOT reimburse the claim. In addition, and equally important, the ordering/referring provider must be registered in PECOS at the time of the order or referral.
In light of Transmittal 386, it is advisable that radiology practice groups identify chiropractors who have referred (or who currently refer) Medicare beneficiaries to ensure that no services are rendered to Medicare beneficiaries as a result of a now prohibited order or referral from a chiropractor.
Since 2009, CMS has actively expanded its claim editing processes in order to meet the Social Security Act requirements for ordering and referring medical providers. Transmittal 386 illustrates that CMS has advanced its claim editing process to the point of eliminating a certain type of practitioner – chiropractors – from the list of medical providers who may order or refer diagnostic services for Medicare beneficiaries.
If you have any questions regarding compliance with Transmittal 386, or any other compliance-related issue(s), please feel free to contact me at
ADVOCATE will continue to provide updates as they become available.
Andre Perrotta, Esq.
Chief Compliance Officer