Comprehensive Error Rate Testing (CERT)

The CERT program is designed to determine if Medicare contractors are processing and paying claims correctly. The Centers for Medicare and Medicaid Services (CMS) developed the CERT program to determine national, contractor specific, provider compliance error rates, paid claims error rates, and claims processing error rates. Every month, the CERT contractor selects a random sample […]

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Medicare Patients with Part A Only

The only service covered by Medicare for a Chiropractor is the adjustment (98940, 98941 & 98942). All services other than adjustments should be charged to the patient at your regular fee (unless the service is a bundled service). Chiropractic is covered under Medicare Part B which is for physician services. Medicare patients can choose to […]

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Requirement to Transmit Records Electronically

Quality Improvement Organizations (QIO) manage all Medicare beneficiary complaints and quality of care reviews to ensure consistency in the review process. When a QIO receives a written complaint about the quality of services received by a Medicare beneficiary, the QIO will request a copy of the medical record. The Centers for Medicare and Medicaid Services […]

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Requirement to Retain Records

Your are required to retain the medical records on your patients. For HIPAA puroposes you must keep the records for 6 years from the date of the patient’s last visit. However, this is not the only rule that applies. Each state can have it’s own requirement. The requirement to retain records for minors generally begins […]

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  • Updated February 17, 2021
  • Legal

NPI Numbers in Blocks 24j and 33a

The billing provider is the entity that is sending the insurance claim to the insurance company. This is usually the doctor’s corporation or the doctor himself if he is not incorporated or the company that is doing the billing for you. The billing provider is the entity that receives the insurance check when assignment is […]

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PQRS Pain Assessment G Codes Retired

Physician Quality Reportins System pain assessment G codes have been retired as of 12-31-2020: G8730 – pain assessment documented positive AND follow-up plan documented G8731 – pain assessment documented as negative, no follow-up plan required G8442 – patient not eligible for pain assessment for documented reasons G8732 – pain assessment not documented, reason not specified […]

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R51 Headache Code Change

R51 – headache (cephalgia) became invalid 10-01-2020 as it has been replaced by more specific codes. Headache R51- Type 2 Excludes atypical face pain (G50.1) migraine and other headache syndromes (G43-G44) trigeminal neuralgia (G50.0) R51.0 Headache with orthostatic component, not elsewhere classified R51.9 Headache, unspecified Orthostatic means relating to or caused by an upright posture. […]

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Active/Corrective vs Maintenance

Contrary to popular belief, there are no caps/limits for covered chiropractic care. There may be review screens (numbers of visits at which the Medicare carrier may require a review of documentation), but caps/limits are not allowed. The Social Security Act provides that Medicare will only pay for items or services it determines to be “reasonable […]

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New Medicare ABN

A new Advanced Beneficiary Notice (ABN) has been made available. Due to COVID-19 concerns, CMS has extended the deadline for use of the renewed ABN, Form CMS-R-131 (exp. 6/30/2023).  At this time, the renewed ABN will be mandatory for use on 1/1/2021. The renewed form may be implemented prior to the mandatory deadline. The ABN […]

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Health Professional Shortage Areas

Health Professional Shortage Areas (HPSAs) are geographic areas, that lack sufficient health care providers to meet the health care needs of the area or population. The Centers for Medicare & Medicaid Services (CMS) provides a 10 percent bonus payment when you furnish Medicare-covered services to beneficiaries in a geographic HPSA. The HPSA list is updated […]

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