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Physicians must be sure to pay close attention to the compliance and billing issues associated with the practice of "non-traditional" medicine.
Recently I’ve had several clients looking to expand their medical practices to include non-traditional and complementary health services. The reasons for such expansion may be personal beliefs or a desire to improve the practice’s bottom line. Whatever the inspiration, physicians must be sure to pay close attention to the compliance and billing issues associated with the practice of "non-traditional" medicine.
When I talk about "alternative medicine," I am referring to treatments (and sometimes the providers of such treatment) that may not have yet achieved a level of scientific validity and reliability in our culture, so as to be considered mainstream, viable treatment alternatives. Although many patients and providers swear by the efficacy of such treatment alternatives, many payers and physicians will still not accept their value at this time. These less traditional treatments and services might include naprapathic medicine (therapeutic treatment, manipulation and nutrition to treat pain and other symptoms associated with connective tissue disorders), homeopathy (treating the individual with certain substances with the aim of triggering the body’s natural system of healing), and pan-holistic treatments. Some of these alternatives are considered a bit more mainstream than others. Nutrition and massage are more mainstream than "energy work."
Most non-traditional treatments are not covered by Medicare, but may be covered by major commercial insurers in certain, patient-specific circumstances. For example, massage and acupuncture are not generally covered by Medicare, but are reimbursed by many commercial insurers with certain restrictions on the number of sessions and reason(s) for treatment. When choosing to offer alternative services as part of your practice, it is important to carefully research the payer policies that cover your patient base. If offering such "non-covered" services to Medicare patients, be sure you meet all legal guidelines. I always recommend obtaining legal and billing advice from professionals when bringing alternative services into your practice. While associations focused on alternative specialties can be helpful, many clients have mistakenly depended on billing/legal advice they received, to their detriment. As with all medical services, regular billing audits are highly recommended to assure compliance.
It is also very important for practices to understand that it is not only the type of provider whose services are not covered, but also the service itself regardless of the provider. With respect to Medicare, this means that acupuncture, for example, is not reimbursable whether it is performed by an acupuncturist (whose services are not covered by Medicare) or a physician (whose services are generally covered by Medicare). In reality, this means that you cannot bill acupuncture services provided by an acupuncturist, a physician, or an acupuncturist as incident-to the physician’s services. A misunderstanding of this point can often be confusing for providers.
Regardless of who pays for the treatment, it is important that physicians take the time to review and understand existing science and peer-reviewed support for newly offered services. Recent changes in health law policy (the Affordable Care Act) highlight the trend toward evidenced-based medicine. When thinking about offering non-traditional treatments to your patients, make sure to research the credentials and educational backgrounds of alternative medicine providers and to verify the availability and scope of professional liability coverage for their services. Make sure you are also aware of restrictions that come with selling products to patients related to the alternative care (vitamins, crystals, magnets, etc.). The same rules apply as with anything a physician sells to patients, an issue I addressed in a prior blog.
Non-traditional and complementary services can be a great health benefit to your patients, a source of expanded revenue for your practice, and can expand a physician’s experience on the benefits of alternate treatments and techniques. With careful planning, you just may find that expanding your horizons beyond the practice of traditional western medicine is just what the doctor ordered.
Find out more about Ericka L. Adler and our other Practice Notes bloggers.