The chiropractic manipulative treatment (CMT) includes a pre and post service evaluation. The insurance companies, to their advantage, interpret this to mean that the “pre and post service” constitutes an Evaluation and Management service. When a CMT and E&M occur on the same visit/day, they will generally pay the least expensive service (the CMT) and […]
Continue readingInsurance companies use optical scanners to read paper claim forms and convert the information on them into an electronic format. This prevents the claim from having to be keyed into the computer by hand. Scanners can read approximately 2500 claims per hour and they have a 97 to 98 percent accuracy rate. Claims must meet […]
Continue readingWhen completing claims for most insurances, item 14 is for the date of onset – the date that the patient’s problem began and this date should be qualified with the qualifier 431 – Onset of Current Symptoms or Illness (The only other valid qualifier for item 14 is 484 – Last Menstrual Period) And item 15 is used […]
Continue readingA short definition of assignment is, “who gets the money | insurance check | EOB.” The insured is the beneficiary of the insurance. In order for you to receive the insurance payment from the insurance company, you need permission from the insured (or other authorized person usually the spouse or parent). Accepting Assignment The insured […]
Continue readingChiropractic services are part of the standard Medical Benefits Package available to all eligible Veterans. All paper claims (HCFA-1500) should be mailed to: VHA Office of Community Care PO Box 30780 Tampa FL 33630-3780 … where they will be converted into EDI (electronic) format. VA claims can also be sent electronically. The payor ID for VA […]
Continue readingSuperbills are a mainstay of the cash practice. They contain information that the patient can use file their own insurance claims. A major problem with a superbill is that since they are simply a printout on plain paper which means that they could be reproduced and fraudulent claims then submitted by the patient. That’s why […]
Continue readingOption 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 […]
Continue readingProviders 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 […]
Continue readingThe 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 […]
Continue readingSequestration is a 2% reduction that is automatically withheld from Medicare payments. These 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 if the non-participating doctor does not accept assignment The […]
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