Paper Claim Printing Standards

Insurance companies use optical scanners to read paper claim forms and convert the information on them into an electronic format. This prevents the claim from having to be keyed into the computer by hand. Scanners can read approximately 2500 claims per hour and they have a 97 to 98 percent accuracy rate. Claims must meet […]

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Medicare Initial Treatment Date

When completing claims for most insurances, item 14 is for the date of onset – the date that the patient’s problem began and should be qualified with the qualifier 431 – Onset of Current Symptoms or Illness (The only other valid qualifier for item 14 is 484 – Last Menstrual Period) And item 15 is used for ‘other […]

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Indicating Assignment on the Claim Form

A short definition of assignment is, “who gets the money / insurance check / EOB.” The insured is the beneficiary of the insurance. In order for you to receive the  insurance payment, you need permission from the insured (or other authorized person usually the spouse or parent). The insured could sign each claim form in block […]

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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 which means that they could be reproduced and fraudulent claims then submitted by the patient. That’s why […]

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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

Do not use hyphens or spaces with the MBI number  when reporting it on the claim form. Number as it appears on card: 1EG4-TE5-MK72 Number as it should appear on claim (block 1A): 1EG4TE5MK72   New Medicare Cards May Have QR Codes New Medicare cards may have a square code, also referred to as a QR (Quick […]

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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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