Blog - Page 4 of 4 - Chiropractic Billing And Coding

Option 2 on the Medicare ABN

Option 2 on the ABN form [the Advanced Beneficiary Notice] should not be used as a way to circumvent the requirement to file the Medicare claim for the patient. Only in the event that a patient requests that you not file their Medicare claim, Option 2 on the ABN form can be used and the […]

Reporting Changes in Ownership or Location to Medicare

Providers have 30 days to update their enrollment information to reflect: A change in ownership An adverse legal action, or A change in practice location. 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 […]

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 AT & GA. 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 […]

Sequestration

Sequestration is a 2% reduction that is automatically withheld from Medicare payments. Due to Covid-19, sequestration has been suspended through December 2021. 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 […]

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 […]

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 […]

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) Mail claims to: Palmetto GBA Attn: […]

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 […]

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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