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 […]

Continue reading

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 […]

Continue reading

ABN Form Expires 03-31-20

CMS has announced on their website that “The ABN, Form CMS-R-131, is currently awaiting OMB approval for renewal. CMS will provide instructions when it does get approved. In the meantime, continue to use the current form until further instruction is provided.” Therefore, please continue to use the current ABN form (i.e. the one indicating the […]

Continue reading

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 […]

Continue reading

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 […]

Continue reading

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 […]

Continue reading

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 […]

Continue reading

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 […]

Continue reading

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, […]

Continue reading

Railroad Medicare

Individuals who have worked 10 or more years of railroad service receive their Medicare benefits through the Railroad Retirement Board (RRB) instead of the Centers for Medicare and Medicaid Services (CMS). The Railroad Medicare card has the Railroad Retirement Board logo in the upper left hand corner instead of the HHS logo and “RAILROAD RETIREMENT […]

Continue reading
1 2 3 4