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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Medicare Sequestration Temporarily Suspended

Section 3709 of the Coronavirus Aid, Relief, and Economic Security (CARES) Act temporarily suspends the 2% payment adjustment currently applied to all Medicare Fee-For-Service (FFS) claims due to sequestration. The suspension is effective for claims with dates of service from May 1 through December 31, 2020. How sequestration affects payment is explained in our Medicare […]

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Modifiers 96 & 97

Modifiers 96 & 97 are intended to be reported with services that are identified as being either habilitative or rehabilitative in nature, such as physical medicine and rehabilitation codes, allowing the payer the ability to differentiate habilitative from rehabilitative services. This differentiation is required by the Patient Protection and Affordable Care Act (Obamacare). Modifier 96 […]

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Illegal Medicare Inducements

Offering gifts and other inducements to Medicare beneficiaries is not permitted. A provider who offers or transfers to a Medicare beneficiary any remuneration that the person knows or should know is likely to influence the beneficiary’s selection of a particular provider of Medicare payable items or services may be liable for civil money penalties of […]

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Medicare Enrollment

In order to legally treat Medicare eligible patients, a doctor must apply and be accepted as a provider in the program. Doctors that are not enrolled cannot legally treat any Medicare eligible patients … not even one! Enrolling in the Medicare program involves completing and submitting various CMS-855 forms. The forms can be submitted by completing […]

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Changing Your Medicare Participation Status

In order to legally treat a Medicare eligible patient you must apply and be accepted as a provider in the program. (Medicare Application blog post) When you apply to be a Medicare Provider you must decide whether or not you will be a participating (PAR) or a non-participating (Non-PAR) provider. To change your participation status […]

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Medicare Fee Schedule

How much you are allowed to charge the Medicare patient for an adjustment and when you are allowed to collect it gets complicated. Plus, the fee schedule is updated every year and sometimes multiple times per year. How much Medicare will actually pay for an adjustment is dependent upon several factors: State and region in […]

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Billing Spinal X-Rays

Full spine x-rays are not considered to be of diagnostic quality. This is expecially true of 14×36 film. So if a chiropractor decides to x-ray the patient’s entire spine, he should take sectional views and bill the exam using three codes as follows: 72040 Radiologic examination, spine, cervical; 2 or 3 views 72070 Radiologic examination, […]

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