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Breaking News: Settlement Agreement, A Big Win For Chiropractic?

 In chiropractic billing, chiropractic patient experience, chiropractic software

Have you heard about the Jimmo v. Sebelius case? 

What does it mean for chiropractic?

Big thanks to Dr. Davila for writing this guest post for Genesis Chiropractic Software!  Here are some words of wisdom and caution from Dr. John Davila…

 There has been a Settlement Agreement in the Medicare Improvement Standard case, Jimmo vs. Sebelius. This case clears the way for thousands of Medicare beneficiaries to receive needed health services to maintain their current level of functioning. The settlement, which represents a significant change in Medicare coverage rules, ends Medicare’s longstanding practice of requiring people to show a likelihood of improvement in order to receive coverage of skilled care and therapy services. Please understand that this case specifically pertains to “…those with disabilities or suffering from chronic illnesses such as Alzheimer’s disease, Parkinson’s disease, ALS, lung disease.”

While this SOUNDS exciting please pay close attention to the following small details:

1. This case didn’t include chiropractic.
2. This case didn’t include neuromusculoskeletal conditions.
3. Someone will have to become a test case and ask an Administrative Law Judge to apply it to their case after getting denied by the carrier.

To accomplish this goal, here is my list of things you’d need to do in order to take a case to the ALJ to have this case apply:

1. Knowingly document a case specifically meant to show no improvement.
2. Knowingly apply the AT modifier to a case that is not improving.
3. Knowingly accept that billing these services (the way the rules are as of today) is equal to committing fraud. This is because the way “abuse” is currently defined; it is treated as if it were fraud.
4. Knowingly take on a case that will last YEARS before it is finally settled.
5. Go in understanding that an ALJ has the right to accept or deny your assertion that Jimmo v Sebelius does apply to your patient.
6. Accept the fact that if denied, your treatment of the patient would be for free as you couldn’t ask the patient to pay for services denied when the AT modifier is attached to the service.

Dr. John Davila, President and CEO of Custom ChiroSolutions, offers chiropractors sound consulting advice on practice management, billing procedures, Chiropractic compliance, Medicare compliance, treatment programs, marketing, and other strategic and tactical custom solutions to help them run a successful practice. For more information on our services please contact Custom ChiroSolutions at (800) 974-3479 or

Read another blog by Dr. John Davila.

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