Important Notes

Updated: February 8, 2011
Dear Doctors and Staff,

1. Item #14 on each and every claim form must not be over 60 days old. If over 60 days old, this will prompt an audit by most Medicare carriers. Item #14 changes with any exam, x-rays, accident or exacerbation, etc.

2. Option #2 on the ABN is designed for non-covered services, x-rays, exams, etc. By calling a Chiropractic adjustment "maintenance care", because the patient has no symptoms and having the patient check Item #2 on the ABN, is incorrect and dangerous. Remember, Medicare does not reimburse for treatment of pain. Medicare reimburses for only the correction of subluxations. Maintenance care is when you perform a non-covered service in Medicare. Correcting a vertebral subluxation IS a covered service. You have the responsibility to document the chiropractic necessity of care. (Option #2 cheats the patient out of reimbursement by Medicare.)

3. No, it is not ok, after Medicare pays a treatment plan to then stop billing Medicare and collect from the patient. (Participating Provider.) Both the doctor and the patient have signed a contract with the Federal Government to follow the Medicare Guidelines. A participating provider can not collect from the patient at time of visit more than the 20% of the Medicare set fee. Ever....PERIOD!

4. All providers, PAR and NON-PAR may be audited. Audits are simply about money and getting it back from the doctor. Nearly all post payment review audits are on participating providers because the participating provider is the one receiving payment from Medicare. (I am only aware of one post Payment Review on a non-participating provider who did not accept assignment and that was hearsay. I personally have never seen a post payment review audit on a chiropractor that did not receive money from their Medicare carrier.)
Audits on non-participating providers not accepting assignment are called Pre-payment Audit Reviews. If a problem is found, the Medicare carrier simply stops making reimbursement payments to the patient.

5. As a participating provider you must collect the 20% Medicare does not pay from the patient or supplemental insurance. It is against the law to practice no out of pocket expense with Medicare.

6. You must bill the payable services with Medicare within one year, including PI, WC, etc. When there is another payer, the AT and GA modifiers are used on the claim form to other payers on this Medicare patient, with copies of the original claims sent to Medicare. (Remember, this is still a Medicare patient.)
BOTTOM LINE: If you wish to learn how to do Chiropractic Medicare correctly, including "documenting" by federal standards, please consider ordering our Chiropractic Medicare DVD and booklet. It explains piece by piece every important step in doing and billing Chiropractic Medicare so there are no limits for the chiropractic adjustment. If you are audited you will have done Medicare correctly and win your audit. You and your staff will be very happy you have this important and mandatory information. I promise it will make a difference in your understanding of Medicare and how you bill Medicare.
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Keep in mind, Medicare is the only insurance type program that if done incorrectly is fraud, a felony, a fine and/or jail.

I promise you will be more than satisfied that you made the right decision to purchase this information or attend our presentation. Please give me a call if you have questions. 1-618-395-3162

Best regards,
Dr. Gary R. Street

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