The chiropractic manipulative treatment (CMT) includes a pre and post service evaluation. The insurance companies, to their advantage, interpret this to mean that the “pre and post service” constitutes an Evaluation and Management service. When a CMT and E&M occur on the same visit/day, they will generally pay the least expensive service (the CMT) and […]
Continue readingInsurance 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 […]
Continue readingWhen completing claims for most insurances, item 14 is for the date of onset – the date that the patient’s problem began and this date 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 […]
Continue readingA 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 […]
Continue readingChiropractic 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. In general, since this is a government program, the claim should follow many of the Medicare rules: The type of insurance indicated […]
Continue readingSuperbills 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 […]
Continue readingAny 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 […]
Continue readingProviders 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 […]
Continue readingDo 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 […]
Continue readingThe 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 […]
Continue reading