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There are many chiropractic DME and regulations.
There are also best practices, typical guidelines, and insurance rules.
Sometimes, you might be tempted to say more laws govern when you can practice than how you can practice.
It’s not enough to know what the rules and regulations are.
You have to apply them the right way to make your practice profitable and sustainable.
So, let’s go over how you and your practice can benefit from the current chiropractic DME rules.
What are DMEs?
Durable Medical Equipment (DME) is anything that a doctor can prescribe for use in your home.
While DME doesn’t have to be billed to a patient’s insurance, under Medicare, for example, you are permitted to prescribe DME under specific circumstances, and you need proper accreditation to do so.
But DME can also be a term applied to any physical equipment in your office that helps you treat your patients better.
Common Chiropractic DMEs
Some of the DME a chiropractor can prescribe include (but are not limited to):
- LSO Braces
- TENS/Garment Units
- Cervical Traction
Using DME can increase your outcome and patient compliance, leading your patients to a healthier and more pain-free life.
Your patients take part in their health care and feel more responsible for their well-being and healing under your care.
You are getting your patients involved increases their pain relief and recovery.
“The Smart Chiropractor’s content, auto posting, and other tools is simply the best ROI I have seen in 20 years of practice.”
Dr. Mike Marino, DC
Marino Chiropractic Clinic
However, there are some significant rules and regulations regarding prescribing and using DME.
Each state has different chiropractic DME rules, and as you filter down through the different types of insurances and other programs, such as workman’s compensation, those rules can get even more complex.
Why Chiropractic DME Rules and Regulations are Needed
Can you imagine a world where anyone can do physical manipulations without consequence?
Having a series of rules and regulations helps focus your work to make sure the profession’s integrity remains intact.
DOs can do very similar things to chiropractors.
Yet, the disciplines are vastly different.
Most people don’t understand the distinction, not understanding the different approaches each practitioner uses for their patients.
Some chiropractors work with massage therapists and specialists in Shiatsu, kinesiology, etc.
This partnership is essential that each keeps to their realm of expertise, and it is the realm of the chiropractor to prescribe and ensure the proper use of DME.
However, many people already misuse medical devices, making conditions worse.
For example, many orthotics, braces, and minor equipment can be bought online.
It can make using proper equipment harder.
So, we have rules for proper use and reimbursement.
The governing body of these rules ends up being comprised of Medicare.
You should familiarize yourself with Medicare’s rules and regulations, even if you choose not to accept Medicare as payment.
Even practitioners who do not take any Medicare payments can still fall under Medicare’s guidelines simply because of the rules.
No medical provider is exempt from Medicare.
From Medicare’s rules, more guidelines get imposed by private insurance, auto insurance, workman’s comp, and any other type of reimbursement, and the process becomes more complicated.
The insurance industry is buried under these rules, with many codes and regulations centered around billing.
For example, massage therapy is used in conjunction with many forms of chiropractic care.
Under normal circumstances, Medicare usually covers massage therapy in conjunction with chiropractic care.
However, some insurance companies and some health savings accounts do not.
In these cases, they can rule that massage therapy is not medically necessary.
To get reimbursement, the primary care provider must refer specifically for the massage therapy portion of treatment, even if it’s part of your service.
Following these compliance guidelines makes sure you’re billing correctly and receive proper reimbursement.
Explicitly dealing with Medicare, you have to pay attention to the proper codes you use and enter into the system.
Many of these codes change, and an improper code could delay or deny payments.
This type of thing can happen more often with private insurance and workman’s comp, however.
Additionally, there is paperwork and HIPAA.
The American Chiropractic Association outlines the documentation required for each patient and the privacy policies you need to use.
You may not be required to document each case extensively, but it can help you in the case of a Medicare audit or legal action.
One crucial factor you should keep in mind is that once a chiropractor’s office opts into receiving Medicare reimbursement, they are not permitted to opt-out.
It’s possible to stop taking patients who use Medicare, thus allowing you to avoid that route of insurance, but you can never leave altogether.
These rules were put in place in 2015 as part of the Medicare Access And Chip Reauthorization Act.
Best Practices Vs. Medical Treatment Guidelines
One of the hardest things you may run into is knowing exactly when to prescribe a DME.
When it comes to referrals, it could be a case of the equipment being deemed medically necessary or simply preventative.
The National Center for Complementary and Integrated Health has a list of best practices and guidelines to help.
Overall, it can come down to coding for insurances.
And this is where you have to pay attention to the rules and regulations for your specific state and the particular insurance you bill.
Fortunately, if you adhere to Medicare standards, the vast majority of potential issues can be eliminated.
Medical necessity is the overarching criterion for payment.
“The correct code for an E&M visit should be chosen based on the complexity of the visit. This is determined by the number of problems and the extent that the problems are addressed and documented in the record. The amount of documentation should not be the primary factor for what level of service is billed.”
Chiropractic DME Rules and Regulations
As a chiropractor, you’ve gone through two different levels of regulations already.
Usually, you were directed to the National Board of Chiropractic Examiners to receive board certification at the end of your education.
Then, you had to obtain your license through your state.
The Federation of Chiropractic Licensing Boards is a primary resource for obtaining licensure, laws, regulations, rules, general practice standards, and general requirements.
Each state has a different requirement, and it may be necessary to contact the specific State Licensing Board before taking the examination or submitting an application.
The Accreditation Commission For Health Care also recommends achieving the Durable Medical Equipment, Prosthetics, Orthotics, And Specialization accreditation, one of the highest recognized accreditations for meeting regulatory requirements and standards.
The face of chiropractic has changed over the many years of existence, and the approaches to legislation have changed significantly, often without chiropractic input.
Keeping up with these changes is challenging.
Navigating It All
While these rules will continue to change may be challenging to navigate, there is still tremendous opportunity for the use of DME for your patients.
Did You Know
Before the Affordable Care Act, Medicare’s rules changed every few months.
A few lines would change, and a few clarifications would come out, but overall the general format remained the same.
During the Affordable Care Act implementation, the rules and regulations for Medicare and the health industry changed as fast as every few hours.
Even with the ongoing pandemic, the rules are changing without the input of doctors, regulators, or patients.
Many of the rules and regulations changing within Medicare and the insurance industry come from medical necessity and specific tools and needs safety.
Unfortunately, regulators believe the medical provider’s responsibility is to keep track of these changes, even though it’s virtually impossible.
One of the best ways to keep involved with the changes is to engage with your local and state chiropractic associations.
These organizations provide updates relevant to the local chiropractic community and keep you updated on regulation changes and laws.
You can also remain proactive.
As a provider for Medicare, you can be informed of changes, or you can pursue the changes on the government website itself.
Many major insurance providers offer routine updates to their policies that you can sign up to get.
Usually, you have to request this and actively take the time to review it.
It’s not easy to keep up with many of these changes, as they can come fast and unpredictably.
Keep in Mind
The rapidly changing rules and complications of Medicare and other insurances drive many chiropractors to a direct-pay model, giving them more opportunities and options to help their patients.
However, that model isn’t perfect, either.
As discussed, most DME provides a significant reimbursement to your clinical practice, making taking insurance more lucrative.
Orthotics, braces, ultrasound equipment, and standard equipment, such as specialty tables, can provide significant relief to your patients, increasing compliance and positive outcomes.
Be sure to become familiar with the rules and regulations and review them often.
As fast as they change, many will remain the same, and knowing where the boundary lies can save you many headaches down the road.
Using DMEs can open you to new ideas and procedures that can expand your range of services and provide better relief to your patients.