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

Any HCFA 1500 paper claim form submitted for Medicare Part B claims that is on a version other than the current 02/12 version will be returned to the provider. You should be aware that there is at least one print vendor selling the outdated version 09/19 of the HCFA 1500 form. Our clients have always […]

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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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