Evaluation 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 It has been replaced by more specific codes.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 […]
Continue readingIn 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 […]
Continue readingA 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 […]
Continue readingThe 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 […]
Continue readingThe 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 […]
Continue readingQuality 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 […]
Continue readingYour 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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