The 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 […]
Continue readingIn order to meet the electronic health records requirements for Medicare billing, the software used must be CMS certified. Meaningful use must be established every year. In order to do that, 20 of 25 criteria and fifteen core objectives and five of ten menu objectives must be met. Plus you must enter the required data […]
Continue readingIn the Medicare program the only covered service for a Chiropractor is the Chiropractic Manipulative Therapy (CMT) – the adjustment. ALL other services are non-covered and should be modified with a GY modifier indicating that the service is a non-covered service. You are NOT required to file non-covered services to Medicare. As a matter of fact, […]
Continue readingWireless networks are subject to being breached and all your patient information being stolen. Stolen protected health information (PHI) is a serious HIPPA violation. Click here to see how wireless networks are compromised. Protect yourself and your patients … insist that your network be cabled … not wireless.
Continue readingThe billing of an Adjustment (CMT 98940, 98941 or 98942) and a Manual Therapy Technique (97140) on the same visit is not generally allowed. The rationale is due to overlap of preservice, intraservice, and postservice work that is inherent to both codes. The intraservice overlap occurs as the provider identifies the osseous, articular, and soft […]
Continue readingEvaluation and Management services (E/M) can be selected based on medical decision making (MDM) or Time. Codes should be chosen based upon the severity of the presenting problem, intensity of management and other aspects of medical necessity. A prolonged service is a service that requires more time than that specified in the E/M code. Prolonged […]
Continue readingHow much you should bill to Medicare and how much you should collect from the patient is dependent upon several factors: Is the doctor a participator Is the doctor a non-participator not accepting assignment Is the doctor a non-participator accepting assignment What is the Medicare fee schedule for your state and region Is Medicare traditional […]
Continue readingOnce a Medicare patient has completed his treatment plan he should be treated thereafter on maintenance care which is not payable under Medicare rules. Although maintenance adjustments are not payable, they are still a covered service and must be filed. In order for you to be paid for these adjustments the patient should sign an […]
Continue readingAs of October 1, 2021, M54.5 (Low Back Pain) is no longer a valid diagnosis code. It has been replaced by more specific codes. This means that all your existing patients with a M54.5 diagnosis must be updated. The new valid codes are as follows: M54.50 Low back pain, unspecified M54.51 Vertebrogenic low back pain […]
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