VA benefits are primary to Medicare and Medicare should NOT be billed as the secondary insurance coverage: Medicare does not pay for services authorized under Veterans Health Administration (VHA) benefits. However, Medicare may cover and pay for services not authorized under VHA benefits. Both Medicare and and the U.S. Department of Veterans Affairs (VA) may […]
Continue readingAs of October 1, 2024, M51.36 & M51.37 the codes for ‘Other intervertebral disc degeneration, lumbar region / lumbosacral region’ are no longer valid. These codes must now be coded to the 6th digit. The new valid codes are as follows: M51.36 Other intervertebral disc degeneration, lumbar region M51.360 …… with discogenic back pain only M51.361 […]
Continue readingThe provider of Medicare covered services is required to file the claim for the patient. The provider cannot provide a “super bill” to the patient so that the patient can file their own Medicare claim. Chiropractors cannot Opt-Out of the Medicare program and treat patients under a private agreement. Even if a provider is non-participating […]
Continue readingPersonal Injury Course If an auto accident policy has lapsed because the premium hasn’t been paid, there may be a grace period. The grace period could be applied in one of two ways by the insurance company: If you have an accident in the grace period, the premium could be brought up to date and […]
Continue readingInsurance Course When verifying insurance coverage, it’s important to know when the next deductible comes due. Most insurance policies operate on a calendar year basis. The patient must meet a new deductible on January 1st every year. Some policies however may operate on a fiscal year basis. New deductibles could begin at any time during […]
Continue readingA Pro Re Nata (or PRN which means “as needed”) visit is a stand-alone treatment episode. It is not considered a subsequent visit and must be treated as an initial visit. Therefore, all the required components of an initial visit are also required for PRN visits. The main difference that sets a PRN visit apart […]
Continue readingYour patients’ Medicare ID number may change following data breach In response to a recent data breach, the Centers for Medicare & Medicaid Services (CMS) is mailing approximately 47,000 Medicare cards with new Medicare Beneficiary Identifier (MBI) numbers to those affected. Medicare covers more than 65 million people, so the odds of one of your […]
Continue readingAs of October 1, 2023, M50.22 (Other cervical disc displacement, mid-cervical region) is no longer a valid diagnosis code. It has been replaced by more specific codes. The new valid codes are as follows: M50.220 …… unspecified level M50.221 Other cervical disc displacement at C4-C5 level M50.222 Other cervical disc displacement at C5-C6 level M50.223 […]
Continue readingThe Office of Management and Budget approved the Advance Beneficiary Notice of Noncoverage (Form CMS-R-131) for renewal. This renewed form expires January 31, 2026. The expiration date is the only change to the form. You may use the renewed form now, but you must use it beginning June 30, 2023, when the previous version expires. […]
Continue readingMedicare should not be billed for services if payment has been made or can reasonably be expected to be made, by the following primary plans when certain conditions are satisfied: Group health plans Workers’ compensation plans Liability insurance No-fault insurance The details of the ‘certain conditions’ are spelled out in our Medicare Course If the […]
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