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Category Archives for "Medicare"

Medicare Enrollment

In order to legally treat Medicare eligible patients, a doctor must apply and be accepted as a provider in the program. Enrolling in the Medicare program involves completing and submitting various CMS-855 forms. The forms can be submitted by completing and mailing in the required forms or online using the Medicare Provider Enrollment, Chain, and […]

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Changing Your Medicare Participation Status

In 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 […]

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Medicare Fee Schedule

How much you are allowed to charge the Medicare patient for an adjustment and when you are allowed to collect it gets complicated. Plus, the fee schedule is updated every year and sometimes multiple times per year. How much Medicare will actually pay for an adjustment is dependent upon several factors: State and region in […]

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Railroad Medicare

Individuals 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 […]

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GP Modifier for Therapies

Insurance 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 […]

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Billing X-rays To Medicare

If 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 […]

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Important Medicare Legislation

Legislation championed by ACA to increase Medicare coverage of chiropractic services has been introduced in the U.S. House of Representatives. The Chiropractic Medicare Coverage Modernization Act of 2019 (H.R. 3654) would allow Medicare beneficiaries access to the chiropractic profession’s broad-based, non-drug approach to pain management, which includes manual manipulation of the spine and extremities, evaluation […]

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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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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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