Medicare Archives - Page 3 of 4 - Chiropractic Billing And Coding

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 […]

Billing Spinal X-Rays

Full spine x-rays are not considered to be of diagnostic quality. This is expecially true of 14×36 film. So if a chiropractor decides to x-ray the patient’s entire spine, he should take sectional views and bill the exam using three codes as follows: 72040 Radiologic examination, spine, cervical; 2 or 3 views 72070 Radiologic examination, […]

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 […]

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 […]

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 […]

Medicare Patients In Auto Accidents

Here are some basic things you must understand about billing Medicare for services to a patient that is or may be covered by liability insurance: Any liability coverage is the primary coverage – Medicare is secondary. You must wait 120 days from the date of service before you can bill Medicare (this is known as […]

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 […]

Medicare Initial Treatment Date – Blocks 14 & 15

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 […]

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 […]

Reporting Changes in Ownership or Location to Medicare

Providers 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 […]

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