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Category Archives for "Medicare"

Medicare Overpayments

A Medicare overpayment is a payment that exceeds amounts properly payable under Medicare statutes and regulations. When Medicare identifies an overpayment, the amount becomes a debt you owe the Federal government. Federal law requires the Centers for Medicare & Medicaid Services (CMS) to recover all identified overpayments. Medicare overpayments commonly occur due to: Incorrect coding […]

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New Medicare Card: 0 not O

The Medicare Beneficiary Identifier (MBI – which replaces the patient’s social security number) uses numbers 0-9 and all uppercase letters except for S, L, O, I, B, and Z. These letters have been excluded to avoid confusion when differentiating some letters and numbers (e.g., between ‘0’ and ‘O’). You should start using the new MBI […]

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Medicare Initial Treatment Date

When 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 […]

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Option 2 on the Medicare ABN

Any time that you reasonably expect that Medicare will not pay for the adjustment, you should have the patient sign an Advance Beneficiary Notice or ABN. Option 2 on the ABN form only applies to non-covered services. Since the only covered service for chiropractic is the adjustment, this is the only service that is generally listed on […]

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Reporting Changes in Ownership to Medicare

Providers must update their enrollment information to reflect changes in ownership within 30 days. 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 Related to Provider Enrollment and Ownership Disclosure OIG Report, May 2016 Timely […]

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New Medicare Card

Do not use hyphens or spaces with the MBI number  when reporting it on the claim form. Number as it appears on card: 1EG4-TE5-MK72 Number as it should appear on claim (block 1A): 1EG4TE5MK72   New Medicare Cards May Have QR Codes New Medicare cards may have a square code, also referred to as a QR (Quick […]

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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 ATGA. 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 and that […]

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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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