Medicare Provider Must File Claim

The provider of Medicare covered services is required to file the claim for the patient.

The provider cannot provide a “super bill” to the patient so that the patient can file their own Medicare claim.

Chiropractors cannot Opt-Out of the Medicare program and treat patients under a private agreement.

Even if a provider is non-participating and does not accept assignment he is still required to file the claim(s) for the patient.

Maintenance visits in the Medicare program are not reimbursable. They are, however, still considered a covered service and therefore must be filed. Maintenance visits should be filed without an AT modifier.

For Chiroprctic, the only covered service is the adjustment – the Chiropractic Manipulative Therapy (CMT)

If Medicare is secondary and the primary insurance pays 100% of the Medicare approved charge you should not submit that adjustment to Medicare. The service is considered paid even if the benefit was taken for the deductible.

You are not required to file non-covered services to Medicare. The only time that you should file a non-covered service to Medicare is if you need a denial of the service in order to file the service to a secondary insurance. If non-covered services are filed, they should be modified with the GY modifier.

Medicare Supplemental (Medigap) policies are not considered to be secondary insurances. When a Medicare claim is processed it is automatically crossed over to the supplemental policy. The supplemental policy information does not have to appear on the claim form.

All claims must be filed on the current version of the HCFA-1500 claim form. The claim form must be printed on the back to be a valid form. Click This Link for more information about the HCFA-1500.

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