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Wednesday, March 9, 2011

Question: Do I have to bill Medicare for a Medicare patient with a Personal Injury Case?

A. FEES: All Medicare Carriers have posted the "NEW" fees for 2011. Go to your Medicare Carrier web page, click FEES. Go to 98940, 98941,98942 to find your fees in your specific local. Remember....the 98940, 98941, and 98942 WITHOUT the (#) sign are your fees in your office for your Medicare patients. The codes with the pound (#) sign are your fees if you adjust your Medicare patient in a facility other than your office.

B. Medicare PI, WC, or other payor than Medicare: When you have a Medicare patient with another payor than Medicare....remember, this is still a Medicare patient and you must follow Medicare Guidelines including billing to Medicare.

When you bill the PI insurance company for this Medicare Carrier, use all modifiers. Example: 98941 AT GA. The AT is active treatment and the GA tells Medicare carrier the patient signed the ABN because Medicare will not pay. Non-participating providers must also remember to NEVER bill the PI or WC insurance above your limiting fees. Participating providers may bill their regular PI fees on this Medicare patient.

Make a copy of the claim to the PI Insurance, one for your records and one you will mail to the Medicare Carrier. Item 10A thru 10C will indicate to the PI insurance that it is their responsibility and will also indicate to the Medicare Carrier NOT to pay this claim. It is billed to Medicare along with a bill to the PI...first because it is the federal law. Secondly, if the patient looses the PI case, now a copy of denial from the PI is sent to Medicare and now Medicare will pay.

NOTE: If you receive money from Medicare on a PI case.....and it is not paid back in a timely manner.....Medicare will take that amount out of your Social Security! This and much more is covered in our Chiropractic Medicare DVD and booklet.

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