Veterans Choice Claims

Chiropractic services are part of the standard Medical Benefits Package available to all eligible Veterans. However, there are a few rules you need to be aware of when filing claims to the VA: All adjustments (Chiropractic Manipulative Therapy – CMT – 98940/98941/98942) must be modified with the AT modifier to be considered. AT indicates that […]

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Rejected Superbills

Superbills are a mainstay of the cash practice. They contain information that the patient can use file their own insurance claims. A major problem with a superbill is that since they are simply a printout on plain paper they could be reproduced and fraudulent claims then submitted by the patient. That’s why we have always […]

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Option 2 on the Medicare ABN

Any time that you reasonably expect that Medicare will not pay for the adjustment, you should have the patient sign an Advance Beneficiary Notice or ABN. Option 2 on the ABN form only applies to non-covered services. Since the only covered service for chiropractic is the adjustment, this is the only service that is generally listed on […]

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Reporting Changes in Ownership to Medicare

Providers must update their enrollment information to reflect changes in ownership within 30 days. Owners are individuals or corporations with a 5 percent or more ownership or controlling interest. Failure to comply could result in revocation of your Medicare billing privileges. Resources: Medicare: Vulnerabilities Related to Provider Enrollment and Ownership Disclosure OIG Report, May 2016 Timely […]

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New Medicare Card

New Medicare Cards May Have QR Codes New Medicare cards may have a square code, also referred to as a QR (Quick Response) code (a type of machine-readable code). The QR codes on Medicare cards allow the contractor who prints the cards to ensure the right card goes to the right person with Medicare or Railroad Retirement […]

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Medicare Adjustment Modifier AT & GA filed to Palmetto

The Medicare contractors have some leeway in the interpretation of the rules. Cahaba allowed chiropractors to modify the adjustment with ATGA. However, it appears that Palmetto does not allow this. The AT modifier is used to indicate that the chiropractic adjustment is provided as an active/corrective treatment for an acute or chronic subluxation and that […]

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Sequestration

Sequestration is a 2% reduction that is automatically withheld from Medicare payments. The Bipartisan Budget Act of 2018 extends sequestration through 2027. Sequestration reductions are borne by whoever payment is assigned to: The Doctor if he is participating because he must accept assignment The Doctor if he is non-participating and chooses to accept assignment The Patient […]

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Requirement to file Electronic Claims

If you are submitting paper claims (HCFA 1500) to Medicare you may receive a letter from you carrier stating “[regulations] require that all initial claims for reimbursement from Medicare be submitted electronically with limited exceptions.” One of the exceptions apply to small practices which is defined as one having fewer than 10 Full Time Employees […]

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Merit-based Incentive Payment System (MIPS)

The Centers for Medicare and Medicaid Services (CMS) announced Nov. 2, 2017, that it will expand the low-volume threshold (LVT) that exempts some Medicare providers from having to report under the Merit-based Incentive Payment System (MIPS). For 2018, providers who treat 200 or fewer Medicare Part B beneficiaries or bill Medicare Part B for $90,000 or less […]

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Palmetto GBA Payer IDs and Mailing Address

Jurisdiction J which was administered by Cahaba GBA has been taken over by Palmetto GBA. This affects chiropractors in Alabama, Georgia and Tennessee. If you are filing your claims electronically, your payer ID must be changed. The Palmetto electronic claim payer IDs are: 10112 (Alabama) 10212 (Georgia) 10312 (Tennessee) The mailing address for part B […]

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