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Category Archives for "Medicare"

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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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 […]

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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

Starting January 1, 2020, you must use the new Medicare Beneficiary Identifier (MBI) regardless of the date of service on all your Medicare claims. After that date, claims submitted with the Health Insurance Claim Number (HICN – the patient’s social security number) will be rejected (with a few exceptions.) If you use the Health Insurance […]

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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 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 […]

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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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