Option 2 on the Medicare ABN

Any 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 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 the […]

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Reporting Changes in Ownership to Medicare

Providers 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 […]

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Medicare Adjustment Modifier AT & GA filed to Palmetto

The 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 […]

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Sequestration

Sequestration is a 2% reduction that is automatically withheld from Medicare payments. The Bipartisan Budget Act of 2018 extends sequestration through 2027. Sequestration reductions are borne by whoever payment is assigned to: The Doctor if he is participating because he must accept assignment The Doctor if he is non-participating and chooses to accept assignment The Patient […]

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Requirement to file Electronic Claims

If you are submitting paper claims (HCFA 1500) to Medicare you may receive a letter from you carrier stating “[regulations] require that all initial claims for reimbursement from Medicare be submitted electronically with limited exceptions.” One of the exceptions apply to small practices which is defined as one having fewer than 10 Full Time Employees […]

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Merit-based Incentive Payment System (MIPS)

The Centers for Medicare and Medicaid Services (CMS) announced Nov. 2, 2017, that it will expand the low-volume threshold (LVT) that exempts some Medicare providers from having to report under the Merit-based Incentive Payment System (MIPS). For 2018, providers who treat 200 or fewer Medicare Part B beneficiaries or bill Medicare Part B for $90,000 or less […]

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Palmetto GBA Payer IDs and Mailing Address

Jurisdiction J which was administered by Cahaba GBA has been taken over by Palmetto GBA. This affects chiropractors in Alabama, Georgia and Tennessee. If you are filing your claims electronically, your payer ID must be changed. The Palmetto electronic claim payer IDs are: 10112 (Alabama) 10212 (Georgia) 10312 (Tennessee) The mailing address for part B […]

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Correct Claim Form Must Be Used

Effective August 30, 2017 any CMS-1500 paper claim form submitted for Part B claims that is on a version other than the current 02/12 version will be returned to the provider. The version number 02/12 is on the top of the claim form and in the lower right hand corner. Be aware that there is […]

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Qualified Medicare Beneficiary (QMB)

QMB is a Medicaid program that assists low-income beneficiaries with Medicare premiums and cost-sharing. In 2015, more than one out of every ten Medicare beneficiaries were enrolled in the QMB program. Patients must apply and be accepted into the program. Doctors should not collect the Medicare deductibles, coinsurance, or copayments from a QMB eligible patient […]

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