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Category Archives for "Medicare"

X-Ray Date No Longer Required

In days past if you depended upon an x-ray to demonstrate subluxation, you were required to show the date of the x-ray in block 19 in the claim form. For example: This is no longer required. Currently, any date placed in item 19 is considered date of last x-ray. It is recommended that providers do […]

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Medicare Card

A Medicare card is issued to every person who is entitled to Medicare benefits and may be identified by its red, white and blue coloring. (See also Railroad Medicare) This card identifies the Medicare patient and includes the following information: • Name • Medicare Number (a randomized alphanumeric number – Medicare cards that bear the […]

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Comprehensive Error Rate Testing (CERT)

The CERT program is designed to determine if Medicare contractors are processing and paying claims correctly. The Centers for Medicare and Medicaid Services (CMS) developed the CERT program to determine national, contractor specific, provider compliance error rates, paid claims error rates, and claims processing error rates. Every month, the CERT contractor selects a random sample […]

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Medicare Patients with Part A Only

The only service covered by Medicare for a Chiropractor is the adjustment (98940, 98941 & 98942). All services other than adjustments should be charged to the patient at your regular fee (unless the service is a bundled service). Chiropractic is covered under Medicare Part B which is for physician services. Medicare patients can choose to […]

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Requirement to Transmit Records Electronically

Quality Improvement Organizations (QIO) manage all Medicare beneficiary complaints and quality of care reviews to ensure consistency in the review process. When a QIO receives a written complaint about the quality of services received by a Medicare beneficiary, the QIO will request a copy of the medical record. The Centers for Medicare and Medicaid Services […]

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PQRS Pain Assessment G Codes Retired

Physician Quality Reportins System pain assessment G codes have been retired as of 12-31-2020: G8730 – pain assessment documented positive AND follow-up plan documented G8731 – pain assessment documented as negative, no follow-up plan required G8442 – patient not eligible for pain assessment for documented reasons G8732 – pain assessment not documented, reason not specified […]

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Active/Corrective vs Maintenance

Contrary to popular belief, there are no caps/limits for covered chiropractic care. There may be review screens (numbers of visits at which the Medicare carrier may require a review of documentation), but caps/limits are not allowed. The Social Security Act provides that Medicare will only pay for items or services it determines to be “reasonable […]

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New Medicare ABN

A new Advanced Beneficiary Notice (ABN) has been made available. Due to COVID-19 concerns, CMS has extended the deadline for use of the renewed ABN, Form CMS-R-131 (exp. 6/30/2023).  At this time, the renewed ABN will be mandatory for use on 1/1/2021. The renewed form may be implemented prior to the mandatory deadline. The ABN […]

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Health Professional Shortage Areas

Health Professional Shortage Areas (HPSAs) are geographic areas, that lack sufficient health care providers to meet the health care needs of the area or population. The Centers for Medicare & Medicaid Services (CMS) provides a 10 percent bonus payment when you furnish Medicare-covered services to beneficiaries in a geographic HPSA. The HPSA list is updated […]

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Modifiers 96 & 97

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 […]

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