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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PQRS Pain Assessment G Codes Retired

Physician Quality Reportins System pain assessment G codes have been retired as of 12-31-2020: G8730 – pain assessment documented positive AND follow-up plan documented G8731 – pain assessment documented as negative, no follow-up plan required G8442 – patient not eligible for pain assessment for documented reasons G8732 – pain assessment not documented, reason not specified […]

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R51 Headache Code Change

R51 – headache (cephalgia) became invalid 10-01-2020 as it has been replaced by more specific codes. Headache R51- Type 2 Excludes atypical face pain (G50.1) migraine and other headache syndromes (G43-G44) trigeminal neuralgia (G50.0) R51.0 Headache with orthostatic (relating to or caused by an upright posture) component, not elsewhere classified R51.9 Headache, unspecified ICD-10 coding […]

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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. Notice: The […]

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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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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 […]

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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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