Charging Full Fee for Medicare Adjustment

Once 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 […]

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Sequestration Changes for 2022

The “Protecting Medicare and American Farmers from Sequester Cuts Act” impacts payments for all Medicare Fee-for-Service (FFS) claims (e.g. chiropractic): No payment adjustment through March 31, 2022 1% payment adjustment April 1 – June 30, 2022 2% payment adjustment beginning July 1, 2022 Sequestration is a reduction that is withheld from any payments. The sequestration […]

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M54.5 Low Back Pain Code Deleted

As 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 It has been replaced by more specific codes.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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X-Ray Date No Longer Required

In days past if you depended upon an x-ray to demonstrate subluxation, you were required to show the date of the x-ray in block 19 in the claim form. For example: This is no longer required. Currently, any date placed in item 19 is considered date of last x-ray. It is recommended that providers do […]

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Medicare Card

A Medicare card is issued to every person who is entitled to Medicare benefits and may be identified by its red, white and blue coloring. (See also Railroad Medicare) This card identifies the Medicare patient and includes the following information: • Name • Medicare Number (a randomized alphanumeric number – Medicare cards that bear the […]

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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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