KCA Medicare Update
The KCA Medicare Committee met this week to review ongoing federal, regulatory, and payer-related developments affecting chiropractic practices.
At the federal level, Medicare parity legislation (HR 539 / S 106) continues to gain attention, but additional co-sponsors are still needed to move the bills forward. A newer proposal (HR 8163) could have broader implications by removing Medicare spending caps across all provider types, which may positively impact future reimbursement.
On the compliance side, a new Advance Beneficiary Notice (ABN) form is now in effect, with a 60-day transition period. Members should ensure their offices have implemented the updated form. Additionally, don’t overlook PECOS revalidation requirements—missing your revalidation window can create significant administrative challenges.
The committee also discussed ongoing concerns with Medicare Advantage plans, including lack of clarity on out-of-network billing and continued issues with claim denials in certain markets. These challenges reinforce the importance of careful documentation and monitoring of payer behavior.
Audit activity remains elevated. CERT audits and third-party reviews (such as CoventBridge) continue to target physical medicine providers, including chiropractors. If you receive an audit request, timely and thorough responses—and pursuing appeals when appropriate—are critical.
Finally, the committee reviewed HIPAA and technology requirements, including the transition to Windows 11 and the importance of annual Security Risk Assessments. Additional federal security requirements for EHR systems are being discussed and may increase compliance expectations in the future.
KCA will continue monitoring these developments and advocating for policies that improve access, reduce administrative burden, and ensure fair reimbursement for Kansas chiropractors.
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