5 Differences Between Credentialing With Medicare and Other Insurance Companies for Chiropractors

Credentialing with Medicare can be a complex process for chiropractors, as it involves specific requirements and administrative processes that are different from those of major medical payers. It is important for chiropractors to understand these differences and work with insurance credentialing services or other resources to navigate the credentialing process.

1. Eligibility: Medicare is a federal health insurance program that provides coverage to individuals over the age of 65, individuals with certain disabilities, and individuals with end-stage renal disease. Major medical payers are private health insurance companies that provide coverage to individuals and groups.
2. Credentialing requirements: Medicare has specific credentialing requirements for healthcare providers, including chiropractors, which are different from the requirements of major medical payers. For example, Medicare requires that chiropractors be licensed and registered with the appropriate state licensing board, and that they have completed at least one year of clinical experience after obtaining their chiropractic degree.
3. Reimbursement rates: Medicare has its own reimbursement rates for chiropractic services, which are different from the rates set by major medical payers. Medicare’s reimbursement rates are typically lower than those of major medical payers, which can impact a chiropractor’s financial viability.
4. Administrative processes: Credentialing with Medicare involves different administrative processes than credentialing with major medical payers. For example, chiropractors must enroll in the Medicare program and submit claims electronically using specific codes and forms.
5. Patient population: The patient population covered by Medicare is different from the patient population covered by major medical payers. Medicare primarily covers individuals over the age of 65, who may have different health needs and preferences than younger individuals covered by major medical payers.

Due to these differences, credentialing with Medicare can be a complex process for chiropractors. It is important for chiropractors to understand Medicare’s specific requirements and reimbursement rates, and to work with insurance credentialing services or other resources to navigate the credentialing process. Additionally, chiropractors may need to consider the unique needs and preferences of the Medicare patient population when providing care.

Ready for Credentialing Made Easy? Click Here to Book Your CredEdge Demo!