Seminars in Washington and Oregon

Date: Saturday, November 4, 2017

Time: 8:30 AM - 12:30 PM

Location: Portland, Oregon

Location address:

 Radisson Hotel Portland Airport

 6233 NE 78th CT

 Portland, OR 97218

Hotel phone: (503) 251-2000 for direction purposes only

To register or for questions please call: (618) 395-3162

Date: Thursday, November 2, 2017

Time: 8:30 AM - 12:30 PM

Location: Pacific, Washington

Location address:

 Quality Inn & Suites

 415 Ellingson Road

 Pacific, WA 98047

Hotel phone: (253) 288-1916 for direction purposes only

To register or for questions please call: (618) 395-3162

Newsletter 8/06/12 ~ "Back to the Basics"

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Newsletter
August 6, 2012
Chiropractic Medicare
"Back to the Basics"

 

The simple fact is "if you do not know how to do Chiropractic Medicare correctly...there is trouble!"  So most important....learn the correct way to do Chiropractic Medicare.

 

We have had the privilege of sharing, with our fellow Chiropractors and their staff, Chiropractic Medicare information for the past 34 years.  We constantly hear remarks like, "I have been in practice for 27 years.  Why didn't someone tell me this before now?" 

 

 You may believe you are doing Chiropractic Medicare correctly.  However, question yourself.  If you receive an audit today in the mail, what does your documentation look like? (Documentation is not S.O.A.P. notes.)  What does your treatment plan look like and does it have all three (3) required elements?

 

Questions? Please call me!  800-MY-CHIRO

"Think Like a Chiropractor"

Newsletter

April 9, 2012

Chiropractic Medicare

"Think Like a Chiropractor"

Dear Doctors and staff,

Many times, when speaking of Medicare, HIPAA, or becoming "compliant" in Medicare, it comes off as a "negative" and a "downer". 

Most people have no idea the Medicare Chiropractic section was written by Chiropractors Dr. Bill Day of Washington, Dr. Bob Hulsebus of Illinois, etc. 

“If we do Chiropractic Medicare as Chiropractors instead of acting like another health discipline, as your Medicare Carriers want you to be, you will have little to no problem with Medicare.”

The Chiropractic Medicare guidelines do not say we are reimbursed for "treating" our patient’s symptoms. It says we are only paid in Medicare for “correcting a vertebral subluxation”.

The vertebral subluxation is the only "covered service" in Medicare for Chiropractors.  The vertebral subluxation is "always" a covered service in Medicare; however, it may not be a payable service if we cannot document the Chiropractic necessity of care. It is always the covered service which is the reason we must bill all Chiropractic adjustments to correct a vertebral subluxation.  For the patient to mark Option #2 on the ABN, calling it maintenance care when the Chiropractor corrects a vertebral subluxation, is very questionable and dangerous.  The adjustment to correct a vertebral subluxation is the only covered service in Medicare and must be billed within one year.

For the Chiropractor to call the Chiropractic adjustment to correct a vertebral subluxation "maintenance care," patient signs Option 2 on the ABN, creates several problems.

1. The patient pays a monthly premium in Medicare for the healthcare that will not reimburse the patient if the Chiropractor does not bill or bill correctly.  The patient is cheated.
2. When a Chiropractor provides a covered service (98940, 98941 or 98942) in Medicare, they are required to bill Medicare within one year.  You may call it Maintenance Care, however, if you corrected a vertebral subluxation that is a "covered service" and should be billed and documented for Medicare reimbursement.
3. Just because a patient has NO obvious symptoms does not make this "maintenance care."  The patient may be on seven (7) prescription drugs and feel no symptoms.
4. When a patient has a "vertebral subluxation", they must have a related "Neuronal Component" or it is not a Subluxation.
1. Example...Subluxation of T6 with the neuronal trajectory of T6 spinal nerve to the stomach altering the function of the stomach. They are probably on three prescription drugs for a stomach problem   from their MD.

Think and be a Chiropractor in Medicare.  That is how the Medicare Program was developed in 1973.

Do you know the importance of learning the correct way to do Medicare by federal standards and becoming Medicare Compliant?

Have questions? Give Dr. Street a call today at (618) 395-3800.

Spring 2012 Seminar Schedule:

*Thursday, April 19, 1:00 pm - 5:00 pm at the Chariot Hotel - Louisville, KY

*Thursday, May 24, 8:30 am - 12:30 pm at King Oscar Hotel, Pacific, WA

*Thursday, May 24, 6:00 pm - 10:00 pm at Staybridge Suites, Mukilteo, WA

To Register Call:  (618) 395-3800

Quitting Medicare

First of all, you must understand that if you continue to provide the payable service of 98940, 98941 or 98942 to any patient that has Medicare coverage, you cannot "Quit" or disassociate yourself from the Medicare Program. 

The only way to avoid the Medicare rules is to provide your covered services for "free" to the Medicare patient, or refer them to other offices that accept Medicare. If you have a Medicare Provider Number, that means you signed a contract giving you privilege to provide Chiropractic adjustments for Medicare consumers, and that you will know and follow all Medicare guidelines.

Chiropractors cannot "OPT-OUT" of Medicare.  You can either adjust Medicare patients and follow the guidelines or provide "free" adjustments or not adjust Medicare patients. How do you get out of paying taxes? You don't. Remember: Medicare is a U. S. Government Program.  Do it correctly or don't do it at all!

If you are correcting vertebral subluxations that is a covered service in Medicare. When you provide a covered service, you must bill Medicare in a reasonable amount of time, one year or less.  Both participating and non-participating providers must collect the 20 % not paid by Medicare, from your patient or their supplemental insurance.  It is against the law to practice "NO out of pocket expenses" with Medicare.

Chiropractic Medicare X-rays (Newsletter from 8/29)

Chiropractic Medicare X-Rays ~ Newsletter from August 29

Medicare is an excellent Chiropractic program.  No other insurance company, PPO, HMO, etc., requires Chiropractic Philosophy, Science and Art as in the Medicare guidelines. Chiropractic Medicare was written by chiropractors (Dr. Day, Dr. Hulsebus, etc.)

There are two(2) parts to Chiropractic Medicare to make a mandatory claim:
    1.  The Chiropractor must prove a vertebral subluxation.
    2.  The Chiropractor must "document" the chiropractic necessity of care by "federal standards."

I strongly recommend doing x-rays on each Medicare patient.  (P.A.R.T. is weak and can be challenged, where as, using your x-rays, you are the authority in regards to locating subluxations.) 

You must have a minimum of two views of each region you adjust (AP & Lateral).  The films must be of good quality and evidence of collination.  The x-ray films must be on location or in a location the doctor has access too, as the Medicare carrier may request those films as they did at the beginning of Chiropractic Medicare.

I suggest doing the following x-rays on each Medicare patient each year.  (If the doctor proves vertebral subluxation by way of x-rays, then the Chiropractor must have a new x-ray that is not over 12 months old, or the Medicare claim will be denied.)
    1 14x36 AP full spine
    1 8x10 Lat. Cervical (including occipital)
    1 7x17 Lat. Thoracic
    1 7x17 Lat. Lumbar (including Sacrum and coccyx)

Chiropractic x-rays are important in that it helps locate vertebral subluxations, pathologies, etc., and they are mandatory for we Chiropractors that use them to prove a subluxation.

Other Payers on a Medicare Patient

There are specific guidelines we all must know and follow as we see Medicare patients that have another primary payer other than Medicare. (e.g., Workers Comp., Auto Insurance, Personal Injury, etc.)  Keep in mind, we are required to bill Medicare for ALL covered services even if there is another payer.

As a Participating Provider, you may bill your normal PI fees on this Medicare patient to all other payers and collect above the Medicare fees from other payers. 

Non-participating Providers, even though they receive the highest reimbursement from Medicare (i.e. the limiting charge), you must NEVER bill or collect from any payer on this Medicare patient above the limiting charge. (The limiting charge is the amount your Medicare carrier has set for your local.)  Item 10a through 10c on the claim form or in the electronic billing format will tell the Medicare Carrier (and other payers) who is responsible for payment.

Make a copy of the claim to the primary payer other than Medicare e.g., Workers Comp., Auto Insurance, Personal Injury, etc., and also, send a copy of the claim to the Medicare Carrier.  Be sure when billing another payer on this Medicare patient, to have the patient sign an ABN each visit, for both covered and non-covered services and use all modifiers, since Medicare will not pay.  (Example:  98941 AT GA)

The advantage of billing Medicare on this PI claim is if the PI claim fails and your patient loses the case, now Medicare will pay most of the claim because it was billed within the year time limit with all the correct modifiers and fees.
 
Questions? Give me a call today at 1-800-MY CHIRO.

Sincerely,
Dr. Street