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Tuesday, August 28, 2012

"ABN - Important!" ~Newsletter 8/14/12

August 14, 2012
Chiropractic Medicare
"ABN - Important!"

If a patient selects Option #2 on the ABN, the service indicated on the ABN does not then become a non-covered service.  However, the doctor does not have to file a claim to Medicare in that particular instance because the patient indicated that he or she agrees to pay out-of-pocket and does not want a claim submitted to Medicare. (However, the patient can change his or her mind, at a future time, and request the provider to submit a claim to Medicare.)  Both participating and non-participating providers are permitted to ask for payment from the patient at the time of service if either Option 1 or Option 2 is selected on the ABN.

It is my opinion that the purpose of the ABN, a rule that supersedes the Mandatory Claims Submission Law, is a simple attempt to supply a process to not bill Medicare for our seniors so the carrier's do not have to reimburse for Chiropractic adjustments.  That is a deceiving way to cheat our seniors from reimbursement in Medicare in which they have already paid, plus they pay a Medicare premium each month for coverage.  I strongly recommend we Chiropractors provide great Chiropractic care to the seniors, learn the correct way to do Medicare and bill Medicare so our seniors get their due reimbursement.

Remember...the ABN should only be presented to patients when the service in question may be denied by Medicare due to medical necessity.  It is not appropriate for the provider to present a patient with an ABN for a service that is expected to be covered.

The Chiropractic adjustment is ALWAYS a covered service by Federal Law and it is the responsibility of the Chiropractor to learn and provide "documentation" so the covered service is payable.

1 comment:

  1. Question: So, even though the law says Chiropractors are not allowed to "opt-out"... you're saying that we can let the patient mark option #2 on an ABN? I understood that option #2 didn't apply to chiropractors because we are REQUIRED to always bill Medicare? Just want to make sure I got this right! Thanks for your blog... a great resource!


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