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 readingOffering 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 readingIn 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 […]
Continue readingIn 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 readingFull 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 readingIndividuals 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 readingInsurance policies are written in segments or riders. Chiropractic services are covered under the chiropractic or physician portion of the policy but therapies are generally covered under a therapy portion. The therapy portion of the policy covers all therapy no matter who provides the service. This means that when a patient comes to you they […]
Continue readingIf diagnostic services are shown on the claim form, the ordering physician’s name should appear in block 17 and his NPI number in block 17b. Block 17 should be qualified with DK which indicates that the chiropractor is the Ordering Provider. The only diagnostic services that a chiropractor will probably do is x-rays (and blood […]
Continue readingHere are some basic things you must understand about billing Medicare for services to a patient that is or may be covered by liability insurance: Any liability coverage is the primary coverage – Medicare is secondary. You must wait 120 days from the date of service before you can bill Medicare (this is known as […]
Continue readingZero State Before you begin treating patients, you should setup the structure of your practice. First off, you should decide if you want to incorporate. A corporation provides a layer of protection for your assets. The laws governing incorporation vary state to state and there are multiple types of corporations so this decision should be […]
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