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Wednesday, April 6, 2011

Understanding Medicare Fees as a Chiropractor

(for Providers that are Participating or Non-Participating, Accepting Assignment or Not)
I know you are very busy.... but please read and understand the importance of this message! It may save you "big bucks"!
We do have a dual fee schedule in our Chiropractic offices. They are our normal customary fees and the fees set for you in your state local by your Medicare Carriers. DO NOT MIX THEM UP!

As a participating provider, even though your Medicare Carrier has a set fee for you, you may bill your Medicare Carrier for a payable service (98940, 98941 and 98942) whatever fee you wish. Your Medicare Carrier has the responsibility to reimburse back to you 80% of the Medicare fee only. Not the amount you billed. You must collect from the patient the other 20%, either from the patient or supplemental insurance, not one penny above the Medicare fee set by your Medicare Carrier.

As a non-participating provider, marking the box you accept assignment (money sent to the doctor), you can NOT bill the Medicare Carrier above the non-par fee set for you by your Medicare Carrier. You also must collect the 20% from your patient or supplemental insurance. You can never receive payment from Medicare or your patient above the non-par fees set for you by your Medicare Carrier.

As a non-participating provider, NOT accepting assignment (running business like it should be run.....patient comes in, gets a great Chiropractic adjustment, goes to the front desk and pays for everything), you can collect from your patient, at time of visit, for the adjustment the "limiting charge" (113% higher than participating provider fees). You bill Medicare the "limiting charge" and the Medicare Carrier pays, to your patient, 80% of the non-par fee and their supplemental insurance pays 20% to your patient.

If either participating or non-participating providers collects money from anyone above the set fees of your Medicare Carrier, the fines begin at $10,000.00 per incident. If a non-participating provider bills the Medicare Carrier or any payer (PI, WC) on a Medicare patient above the limiting fees set by your Medicare Carrier on a Medicare patient, the fines begin at $10,000.00 per incident.

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