More info

For more information on how to bill Chiropractic Medicare please visit

Thank you for your interest!

Tuesday, November 12, 2013

Important Advanced Beneficiary Notice of Non-Coverage Info

November 12, 2013
Chiropractic Medicare
Advanced Beneficiary Notice of Non-Coverage

On September 4, 2012 (yes, 2012) implementation of changes in manual instructions for changes in the Advanced Beneficiary Notice of Noncoverage (ABN) were presented. Some Medicare carriers like WPS were very forgiving and did not enforce the new ABN changes. However, many of the contracted Medicare carriers like National Government Services in Illinois that replaced Wisconsin Physician Services are requiring specific ABN update usage.
The applicability to Limitation on Liability (LOL) apply only when a provider believes that a Medicare covered service may be denied in a particular instance because to is not reasonable and necessary or because the item or service constitutes custodial care, which requires a provider to notify a beneficiary (patient) in advance when he/she believes that items or services billed to Medicare will likely be denied, either as not reasonable and necessary, or as constituting custodial care.
If such notice (ABN) is not given, providers may NOT shift financial liability to patients for these items or services if Medicare denies the claim. Patients are afforded “Limitation on Liability” protection when items or services are denied.
Compliance with Limitation or Liability Provisions: The Healthcare Provider who fails to comply with the ABN instructions risks financial liability and/or sanctions.
The Medicare Contractor will hold any provider who either failed to give notice when required or gave defective notice financially liable. A provider (notifier) who can demonstrate that she/he did not know, and could not reasonably have been expected to know, that Medicare would not make payment will not be held financially liable for failing to give notice.
However, a notifier who gave defective notice may not claim that she/he did not know, or could not reasonably have been expected to know, that Medicare would not make payment as the issuance of the notice is clear evidence of knowledge.
The revised ABN gives way to the Medicare Carriers to simply state; “When the provider bills Medicare and has had the patient sign an ABN on a covered service (98940, 98941, 98942), when the “GA” Modifier is used, the claim will automatically be denied as “Maintenance care”. The combination of “AT” and “GA” modifiers are NOT acceptable and can not be placed in the same billing line on the claim.
With this in mind....the “ABN” does not financially protect the doctor when billing a covered service (98940, 98941, 98942) when the patient signs an ABN and the services are denied by Medicare, since using the “GA” modifier tells the Medicare carrier to “deny the claim”. The providers financial protection is correctly documenting the Chiropractic Necessity of Care and not have the patient sign an ABN. When using the “AT” modifier, the doctor expects the Medicare carrier to pay and will not be held financially liable.

CMS Manual System Pub 100-04 Medicare Claims Processing:
"Chapter 30 Financial Liability Protections, Section 50 - Form CMS-R-131 Advance Beneficiary Notice of Noncoverage (ABN)"

***Special Invitation: Please Join us on November 21st.
Hampton Inn Dayton-Dayton Mall, 8960 Mall Ring Rd., Dayton, OH 8:00 am to 12:00 noon. A great chiropractic Medicare Seminar covering all the important changes in Medicare and becoming compliant.
Call to register at (618) 395-3800.

Wednesday, October 23, 2013

Newsletter from 10/21/2013 and a November Seminar

Newsletter from:
October 21, 2013
Chiropractic Medicare
1. Medicare Window for Enrollees
2. Medicare Replacement Plans

1. Medicare Enrollees: We are presently in the Medicare window for those first Medicare enrollees or for present Medicare patients to change their Medicare Coverage and/or Supplemental insurance. If a Medicare patient goes out of Medicare into a “Medicare replacement” plan, you may wish to inform them of their cost factors. (Medicare replacement plans, both in Medicare and out of Medicare, are cheaper than regular Medicare. The reason...both have a co-pay and other coverage not as complete.)

     If your Medicare patient does a “Medicare replacement plan” for example, three (3) years before they realize the coverage is poor and not as good as Medicare....when they return to Medicare, their premium now in Medicare increases 10% each year they have been out of Medicare for the rest of their life. (Out of Medicare for 3 the premium in Medicare is 30% higher for the rest of their life.)

2. Medicare Replacement Plans: There is Medicare Part A: Hospitalization; Medicare Part B: Physician Services;Medicare Part D: drug Coverage and Medicare Replacement Plans in Medicare and Medicare Replacement Plans out of Medicare.
Those Medicare patients in Medicare, we must follow all Medicare guidelines, even though they may have a $35.00 Co-pay and reimburse nothing.

     However, some Medicare patients bail out of Medicare into a private P.P.O. called “Medicare Replacement”. They also have a co-pay and usually reimburse little or nothing. This replacement is out of Medicare and we are not required to bill or follow Medicare guidelines bill this company for your non-Medicare patient. Now you have agreed to follow all the Medicare guidelines on this NON-Medicare patient in a Medicare replacement PPO outside of Medicare.

     Most Medicare carriers have a program you can access online to check eligibility, get duplicate remittance advice, etc. and it is also where you can find if your patient is in a Medicare Replacement in Medicare or in a Medicare Replacement out of Medicare. Example: WPS has C-SNAP and NGS has CONNEX. Look for yours with your Medicare carrier or call them and ask when it will be available for your area.

Date: Thursday, November 21, 2013
Time: 8:00 AM - 12:00 PM
Location: Dayton, Ohio
Location address:
Hampton Inn Dayton/Dayton Mall 
8960 Mall Ring Road
Dayton, OH 45459
Hotel phone: (937) 439-1800 for direction purposes only
To register or for questions please call: (618) 395-3162  

Newsletter from 10/15/2013

October 15, 2013
Chiropractic Medicare

     A large number of Medicare Carriers lost contracts bringing new Medicare Carriers in several states. If you are in a state with a new Medicare Carrier, be aware of the “Local Coverage Determination” (LCD) changes. CMS delivers the guidelines, however, the Medicare Carriers can produce their own Local Coverage Determinations (LCD) that can have a major impact on your practice. Especially if you are unaware of the changes.
     An Example:WPS Medicare Carrier in Illinois lost their contract to National Government Services (NGS). WPS followed the ABN guidelines as presented by CMS. However, NGS Carrier has indicated that we cannot use the “AT” and “GA” modifiers together. This indicates to them that the patient signed the ABN indicating this adjustment was “maintenance care” which is a non-covered service, and will automatically be denied payment.
If this is true....the doctor has lost the ability to financially protect themselves if a covered service is denied by Medicare.
     ***** sure to visit your Medicare Carrier’s web site, register for webinars and special training presentations. Most carriers have a free service (NGSConnex for Illinois) where you can check eligibility, submit claims and appeals, and obtain financial information.

Newsletter from 10/07/2013

October 7, 2013
Chiropractic Medicare
1. Item #14 – Date of Current.
2. Listening to Your Senior Patients.

1. Date of Current – #14:
Many wonder why the Medicare carrier requests patient records. One of the key reasons is you may have an acute diagnosis, however, the date of current is over 60 days indicating this is a chronic condition. So the Medicare carrier asks for patient records to determine if this is an acute or chronic condition. Date of Current #14 on the claim must never be over 60 days old if you expect payment.

2. Listening to Your Senior Patients:
Probably the most active patients in your practice are your senior patients. They will do about anything. Sometimes it is best we do not know some of the things they do. Usually when they come in with symptoms, it’s from doing things that normally should not have created pain or injury. Most seniors have exacerbationsAn exacerbation is soft tissue insult in a predisposed old subluxated arthritic joint. In other words, normally that activity should have not created a problem. An exacerbation occurs at a specific time. The patient has an old subluxation, degenerative joint disease, and they insult the area causing stretching, tearing, etc., in the predisposed joint called “sprain/strain” (pain).
If this is “documented” correctly, Item #14 is changed. This is worth 1 to 6 visits.
Remember.....You must know the correct way to “document” (not S.O.A.P notes). 

Friday, August 23, 2013

New seminars is September 2013

New seminars is September 2013. See you soon in Washington State and Michigan.
For locations and dates, please see the Seminar Calendar link above or call our office.

Friday, July 26, 2013

Be a Chiropractor in Medicare

Be a Chiropractor in Medicare........Where in the federal law does it say we are supposed to “treat” our patient's pain and symptoms like other health care providers? It doesn't!
The federal law says our job as a Chiropractor is to locate and correct vertebral subluxations. So why do some Chiropractors “treat” their patient's symptoms until the symptoms are gone calling the adjustments “maintenance" or "wellness care” and not bill those adjustments for reimbursement? When the Chiropractor adjusts the Medicare patient, correcting vertebral subluxations, that is the covered service in Medicare. The doctor’s job is to learn how to “document” the need for the Chiropractic adjustment so our senior patients are reimbursed.

Wednesday, July 10, 2013

Free Webinar "EHR Stimulus - Why Moving Now Matters"

Free Webinar "EHR Stimulus - Why Moving Now Matters"
July 10, 2013

The EHR Stimulus payout amount will soon drop! Simply participate in our free webinar to learn how easy it really is to get your EHR stimulus check in the full amount*.
Join ChiroTouch and Dr. Gary Street “Medicare Guru” to learn about this government program. We will also have a Q&A with other practices that have gone through the process in 2012 and have received their checks.
Don’t lose out! Join our free webinar and:
• Learn what steps you can take to qualify for your EHR Stimulus funds
• Learn what your EHR system needs to provide
• Hear from chiropractors who have already attested and received their funds
• Get the latest developments on the EHR Stimulus Program
Thousands of chiropractors have received their five-figure checks from the EHR Stimulus Program - And more chiropractors have received their funds using ChiroTouch than any other software solution in chiropractic!
*Maximum payouts based on current ARRA EHR Stimulus Program

Thursday, July 11th, 10:00 AM Pacific/11:00 AM Mountain/12:00 PM Central/1:00 PM Eastern Time
Registration, follow this link:


Questions – If you have questions, or simply need information, give me a call and I will do my best to help you. This is probably the most important decision of your Chiropractic career!
Plan to attend our future Seminars:
Thursday, July 25th 1:00 to 5:00 pm
St. Louis, MO at the Hampton Inn, Westport
Call our office (618) 395-3800 to register

Wednesday, June 5, 2013

June Seminar location in Indiana

Date: Saturday, June 22, 2013
Time: 9:00 AM - 1:00 PM
Location: Mishawaka, Indiana
Location address:
Holiday Inn Express
420 University Drive
Mishawaka, IN 46545
Hotel phone: (574)277-2520 for direction purposes only
To register or for questions please call: (618) 395-3162

Wednesday, May 22, 2013

Going Paperless

May 22, 2013
Chiropractic Medicare
"Going Paperless Made Simple!"

If you have not become paperless yet, please consider making that move quickly. The final window of opportunity closes the last day of September, so you have 90 days of "meaningful use" prior to 2014. That means you need to be moving on this NOW. To make the whole thing simple, you must purchase or have a certified software.

A certified software will lead you though the process step by step. We have been using ChiroTouch for 18 months. It’s an excellent software written by Chiropractors for Chiropractors. After 44 years of S.O.A.P note’s wonderful.

We "attested" last year, have received our first incentive payment in January....NO more paper. To make the whole thing simple...The Software. There are several out there for sale. I just know about ChiroTouch. If you have questions in regard to attesting or ChiroTouch, give me a call.

More info on the CMS (Centers for Medicare and Medicaid Services) Medicare EHR Incentive Program:

Tuesday, May 14, 2013

Mandatory Revalidation, PECOS, CMS-855, and CMS-588

May 13, 2013
Chiropractic Medicare
Mandatory Revalidation
Many fellow Chiropractors across the states are receiving a Provider Enrollment Revalidation Request from your Medicare Carrier. They are asking us to immediately submit updated Provider Enrollment Paper Application 855 form or Review, Update and Certify information via the internet-based PECOS System.

The Patient Protection and Affordable Care Act, Section 6401, says all new and existing providers must be reevaluated under the new screening guidelines. Medicare requires all enrolled providers and suppliers to revalidate enrollment information every five (5) years. Upon the CMS request to revalidate it’s enrollment, the provider has 60 days from the postmark date of your official letter from your carrier to submit complete enrollment information using one of the following methods:

1. Internet-based Provider Enrollment, claim, and Ownership System (PECOS).

2. Paper Application Form CMS-855.

The new Electronic Funds Transfer (EFT) authorization form CMS-588 is now required to be part of the revalidation package. (for both participating and non-participating providers.)

CMS-588 form can be found at

Have questions in regards to doing Chiropractic Medicare correctly, or becoming Medicare Compliant? Give me a call at (618) 395-3800. Learn the correct way to "Document The Chiropractic Necessity of Care." WE WILL DO OUR BEST TO HELP YOU.

Tuesday, May 7, 2013

1. Back to the Basics 2. History Book

May 6, 2013
Chiropractic Medicare
1. "Back to the Basics."
2. New Chiropractic History Book Introduced.
Knowing the error rate for we Chiropractors is at 72.9% as determined by CERT....knowing that they believe they have over paid we Chiropractors improper payments....somebody will be catching audits for money recovery! CERT says that the primary reason for the improper payment is "insufficient medical record documentation".

You may believe this has nothing to do with you since all of your claims have been paid. However, the 72.9% error rate is on claims that have been paid....improperly. If you believe S.O.A.P. notes is the documentation they are talking about...that’s a mistake! Documentation is not S.O.A.P.’s a document. That is why it is called documentation. That is the exact information I have been attempting to share with my fellow Chiropractors for the past 34 years.

1. The Basics in Medicare: You must prove a subluxation, x-rays each year or a P.A.R.T. form each visit. Item #14 must be less than 60 days old. Diagnosis must support the care rendered . S.O.A.P. notes in a S.O.A.P. note format. You must have "documentation" in the way of a "document" to prove chiropractic necessity of care. S.O.A.P. notes must indicate and support the CPT Code you billed.

2. NEW CHIROPRACTIC HISTORY BOOK INTRODUCTION: D. D. Palmer & B. J. Palmer started producing "The Chiropractor" booklets in December 1904. "The Chiropractor" were produced and printed each month for four years. We have made those available in two large volumes. They come with Certificate of authenticity of first copies. For those interested in Chiropractic History....these are not available anywhere else. We have a limited number available so please email or call if you are interested.

Friday, May 3, 2013

Newsletter ~ Two Questions

May 3, 2013
Chiropractic Medicare
#1. Who’s going to catch the audits?
#2. Mandatory Payment Reductions.

#1. Catching Audits..............

I have presented, time and time again, information in regards to Chiropractors becoming compliant in Medicare. And yet, only about one third have followed the Federal Mandate and Attested.

So....I shall say it again! Do you want to be in Chiropractic practice after 2016? If you don’t......just don’t do anything. If you do, and have not proceeded to becoming compliant, you are in your "Last Window of Opportunity". It’s over prior to 90 days to the end of the year!!

If you believe you do not have to become compliant, you are wrong! Both Medicare and Obama care require your compliance. is against federal law to see a Medicare patient if you are not qualified.

AUDITS: So who’s going to catch the audits? Remember....72.9% of all Chiropractic claims have errors and we Chiropractors are being improperly paid...there will be audits.

Do you think the Chiropractor who has followed the Federal Guidelines, become Medicare Compliant using certified software, has attested, and has records readily available for review...or...the Chiropractor that has not become compliant, is not using certified software and not attested as to becoming Medicare compliant will be audited? The answer is not difficult! You begin with a certified software.

Questions? Give me a call! Don’t procrastinate!! This is important for your future in Chiropractic!

#2. Mandatory Payment Reductions...........

The Budget Central Act of 2011 requires, among other things, mandatory across-the-board reductions in Federal Spending, also known as Sequestration. The American Taxpayer Relief Act of 2012 postponed sequestration for 2 months. The order was set for March 1, 2012. In general, Medicare fees for service claims with dates of service on or after April 1, 2013, will incur a 2 percent reduction in Medicare payment.

Even though beneficiary payments for deductibles and coinsurances are not subject to the 2 percent payment reduction, Medicare payments to beneficiaries for unassigned claims are subject to the 2 percent reduction.

Have questions in regards to doing Chiropractic Medicare correctly, or becoming Medicare Compliant? Give me a call at (618) 395-3800.
Learn the correct way to "Document The Chiropractic Necessity of Care."

Wednesday, May 1, 2013

"Medicare Learning Network" (72.9% Chiropractic Medicare Fail Rate)

April 30, 2013
Chiropractic Medicare
"Medicare Learning Network"
(72.9% Chiropractic Medicare Fail Rate)

Well....we Chiropractors made the Medicare Quarterly Provider Compliance Newsletter again! (Volume 3, Issue 3 – April 2013). The very first report is Comprehensive Error Rate Testing (CERT) Special Study: Provider Types Affected: Physicians and Chiropractors.

Problem description:

The majority of chiropractic services claims errors in this review were the result of insufficient documentation. Note that the Medicare Fee-for-Service 2011 Improper Payment Rate Report’s finding that insufficient medical record documentation was the most common reason (72.9%) for improper chiropractic payment. (See "The Supplementary Appendices for the Medicare Fee-for-Service 2011 Improper Payment Rate Report," released on November 2, 2012 at on the CMS website.)

This type of error occurs when the medical records do not contain enough information for the reviewer to make a decision about medical necessity for the item or service furnished. Some common reasons for insufficient documentation errors were:
  • The documentation submitted did not adequately describe the service defined by the billed CPT code, Healthcare Common Procedure Coding System (HCPCS) code, or HCPCS modifier;
  • The documentation did not include the Date of Service (DOS) or the beneficiary’s name;
  • The was no treatment plan documented to support a plan of care;
  • The signature was illegible.
Other errors in this special study were categorized as medical necessity errors. These errors occur when the medical records contain sufficient documentation for the reviewer to determine that the services billed were not medically necessary based upon Medicare coverage policies.

A common reason for medical necessity errors was that the submitted medical records did not support the need for the service based on the Medicare National Coverage Determination (NCDs) and Local Coverage Determinations (LCDs). The rest of the medical necessity errors were due to claims in which the beneficiary symptoms were not related to the spinal regions manipulated.

Example: Mr. Jones’ medical record shows that he had an injury that led to a subluxation of the spine with acute back pain. However, as required by the chiropractic services LCD, the precise level of the subluxation was not specified by the Chiropractor. This claim was scored as an improper payment due to an insufficient documentation error.

Let’s Get Back to the Basics! The statistics indicate 72 out of every 100 claims filed were paid improperly. If you are going to stay in practice and do Medicare and Obama Care, you simply have to do it correctly!!

Recommendation – Have questions in regards to doing Chiropractic Medicare correctly, or becoming Medicare Compliant? Give me a call at (618) 395-3800. Learn the correct way to "Document The Chiropractic Necessity of Care"!

Tuesday, April 23, 2013

Important: Senior Medicare Discounts

April 22, 2013
Chiropractic Medicare
Important: Senior Medicare Discounts

If you have a health fair....or spinal screening....or some type of special offering in your practice for some type of special at a discounted fee, you can not discriminate against your senior patients. In other can give senior Medicare patients the same discounts as you do your regular patients. If the discount is on non-covered services in Medicare, you can give those seniors the same discounts as your regular patients.

If the discounts are on covered services (98940, 98941, 98942), you can give those discounts to the seniors, however, you must pass those discounts on to the carrier. You can not advertise specifically for Senior discounts for non-covered services to Medicare patients, as doing so is a breach of federal law.

You can advertise discounts for covered services (98940, 98941 and 98942) as long as you pass that discount onto the Medicare Carrier.

Have questions in regards to doing Chiropractic Medicare correctly, or becoming Medicare Compliant? Give me a call. WE WILL DO OUR BEST TO HELP YOU.

Wednesday, March 20, 2013


March 19, 2013
Chiropractic Medicare

The Medicare Electronic Health Record (EHR) Incentive Program is still alive and well. Incentive direct deposits are taking place across the country in the amount of up to $18,000.00 for those who have successfully attested for 2012.

The amount of your incentive payment depends on when you began participating in the program. The incentive payment is 75% of your Medicare allowed charges up to a maximum annual cap.
"The total maximum incentive amount that you can be paid under the Medicare EHR Incentive Program is $44,000 over five consecutive years of program participation. As you can see, you receive the maximum incentive by starting in 2011 or 2012 . If you don’t start by 2014, you are not eligible to receive any incentive payment under the Medicare EHR Incentive Program." -Page 15 of "An Introduction to the Medicare EHR Incentive Program for Eligible Professionals" found here: (

Example: If you attested before the end of 2012, you have received up to $18,000.00 incentive money in your checking account. If you continue Electronic Health Records in 2013, you will receive another deposit in your checking account in the amount of up to $12,000.00. When you continue for 2014, you will receive another deposit of up to $4,000.00 and if you continue in 2015, you will receive up to a final $2,000.00 deposit.

If you start now and attest in a timely manner this year, you will receive up to $12,000.00, next year for 2013, and up to $8,000.00 in 2015 form 2014. If you wait to attest in 2014, you have waited to long, and then in 2016 you will begin receiving cuts in your Medicare fees and probably other health insurance fees for the rest of your practicing years. Those that are doing Electronic Health Records presently will continue receiving increases in the fee structure instead of cuts.

How do you begin? First, is your office software certified? If it is, then call your software company and get it going. DO IT NOW! It's later than you think! If your office software is not certified look for one that is and get going. We have used Chirotouch for over one year and love it. If you have an interest in Chirotouch give me a call and I can save you some bucks.


D.D. Palmer wrote "The Chiropractor" booklets each month, 1904 thru 1908. Those are what B. J. Palmer used to create the first Chiropractic Book in 1906. We now have those "The Chiropractor" booklets in two (2) large books. If you like history, these are a must! Call me or send an email for more information.

Tuesday, March 12, 2013

ABN Electronic

March 11, 2013
Chiropractic Medicare
ABN Electronic

ABN: Electronic retention of the signed paper document is acceptable. Notifiers may scan the signed paper version of the ABN for electronic medical record retention and, if desired, give the paper copy to the beneficiary (patient) at time of visit.

Centers of Medicare and Medicare Services (CMS) currently does not have a written policy on the electronic issuance of ABN’s. However, it is not prohibited. These are the CMS recommendations offered to provider/suppliers at this time:

a. If an electronic issuance system is used, the beneficiary (patient) must be given the option of requesting paper issuance over electronic, if that is what he/she prefers.

b. ABN’s can be printed for issuance, the paper copy signed by the beneficiary then scanned for electronic health record (EHR) retention, and the original paper copy can be given to the beneficiary.

IMPORTANT: Electronic issuance system can not be located and used at the front desk. The doctor must see the patient, make an assessment, then the patient may sign the ABN prior to any services today.

The ABN or Advanced Beneficiary Notice of Noncoverage link to the form

The ABN or Advanced Beneficiary Notice of Noncoverage information

Tuesday, March 5, 2013


February 25, 2013
Chiropractic Medicare

1. EHR-Registration and Attestation System.
( How much will YOU get paid?)
2. CMS A+ Government Solutions – “Comparative Billing Report, CBR Desseminator.
3. CAQH Update Reminder.

1. Meaningful Use:
We can go through the 15 core operatives, the computerized provider order entry (CPOE), drug-drug and drug-allergy checks, up to date problem list of diagnosis, E-Prescripting (eRx), or maintaining active medication list or allergy list....’s better than this!
First impression is that it is very difficult. Not true. It’s much easier than you think. First, you must have a certified “software”. We use “ChiroTouch”. Your certified software will walk you right through the process so you can register and attest. Don’t wait. If you have not moved on this, you are presently in the final window. You are still able to attest and receive $15,000 incentive dollars for 2013.
2. A+ Government Solutions on contract from CMS has faxed again around 5000 Medicare Comparative Billing reports. If you received by fax, this report, then you are now aware you are above your peers in either the number of visits you are seeing your Medicare patients or the CPT Codes used when billing for your Medicare patients. The report is an effort by CMS to educate providers on their billing patterns, this being helpful as an educational tool which may assist you in identifying opportunities for improvement.
Since the Office of Inspector General believes that billing Medicare with the AT modifier over 12 visits per year is medically unnecessary, and that the likelihood of a service being medically unnecessary increases even more significantly after 24 “treatments”, this report should spark your interest.
I recommend reviewing this report very carefully, compare with your in-house records for the report accuracy. If you find the CMS Comparative Billing Report statistics are incorrect, call them for corrections.
3. CAQH – Just a reminder.....the Universal Provider Data Source must be kept up-to-date. If you need to update the CAQH Universal Provider Data Source or Provider help desk at (888) 599-1771. Have your CAQH provider ID available.

CAQH, CMS 855i, and Audits

March 4, 2013
Chiropractic Medicare
CAQH Reminder

Another reminder to update your CAQH Universal Provider Data Source credentialing. To update your application, go to CAQH Universal Provider Data Source Failure to update your information may jeopardize the relationship between you and your authorized participating plan.

CMS 855i Application,, another timely form, must be completed every 5 years or anytime you have data change (name, address, etc.). Check your records to be sure your CMS 855i application has not surpassed 5 years. You may not receive a notice from your Medicare carrier, just denial of Medicare claims.

NOTE: Now that the EHR Registration and Attestation System comes to an end, I suspect we again will see Medicare audits. It will be interesting to see if the majority of Medicare audits will be with those Chiropractors that went through the Medicare Attestation and received incentive payments or will be done on those Chiropractors that did not become certified.

2013 Spring Seminar Schedule:
March 21 - Kokomo, Indiana at the Courtyard Hotel Kokomo – 1:00 pm to 5:00 pm, EST.
March 23 – Bluffton, South Carolina at Unitarian Universalist Church – 12:30 pm to 5:30 pm EST.

Wednesday, February 20, 2013

More ABN discussion

Newsletter from February 18, 2013
“ABN Advanced Notice of Non-coverage”

NOTE: This is the only document in your office that can not be stored electronically. It must stay in the original paper form. Either stored per patient or by date for fast recovery if requested by your Medicare carrier.

It has become my conclusion the ABN in it’s origination has but one primary cut reimbursement by the Medicare Carrier. It contains rules that supersede the Federal law of mandatory claim submission. It has led many a Chiropractor down the yellow brick road of “Treating Patient Symptoms” instead of locating and correcting vertebral subluxations like Federal Law indicates.
When a Chiropractor calls the chiropractic adjustment that corrected a vertebral subluxation “Maintenance Care”, and had the patient check Option 2 on the ABN to not bill Medicare because it is called “Maintenance Care” since the patient felt no symptoms...and then collected from the patient, the regular office fee (not the Medicare fee) at the time of visit....Who Got Had?
The consumer (patient) just got cheated out of Medicare reimbursement. They pay over $100 dollar premium for Medicare each month. You say the patient had no symptoms. Consider this, as many as 1,800,000 seniors over the age of 65 may be dependent on Medicare-provided prescription drugs. The average number of prescriptions per year for each senior is 38.5 with the average number of different prescriptions daily being 5 or more.
Most of our patients are on 5, 6, 8, 10 drugs each day....they can not feel their symptoms. And yet, if the patient has no symptoms we just call it “Maintenance Care” and then not bill Medicare. I don’t think so! Our job as Chiropractors is quite clear in Medicare. We do not get paid to “treat” symptoms. We are only paid in Medicare to locate and correct vertebral subluxations.
If the patient have a subluxation and no pain symptoms....How about that subluxation of T6 spinal nerve and the trajectory of that nerve to the stomach, altering the normal function of the stomach. They are already on three prescription drugs for a stomach problem. S.O.A.P. notes shall indicate your findings, and your documentation will support the care given. I recommend, when you correct a vertebral subluxation, call it what it is....The primary job you do, and it is covered by Medicare. Help your patients get reimbursed in Medicare for the Chiropractic covered service of correcting a subluxation.

Judge Approves Change to Medicare Improvement Rule, Health Services

Newsletter from February 15, 2013
Medicare Settlement Means No More “Improve or You’re Out”
Originally Posted on 02/6/2013 by Amy Goyer 
Judge Approves Change to Medicare Improvement Rule, Health Services

     A Federal Judge has approved the proposed Settlement Agreement in the Medicare Improvement Standard case, Jimmo vs. Sebelius, clearing the way for thousands of Medicare beneficiaries to receive needed health services to maintain their current level of functioning.
     The settlement, which represents a significant change in Medicare coverage rules, ends Medicare’s longstanding practice of requiring people to show a likelihood of improvement in order to receive coverage of skilled care and therapy services.
     The Agreement, which is retroactive to the date of the suite was filed, January 18, 2011, includes skilled services covered by Medicare Part A and Part B, such as speech, occupational and physical therapy, nursing and home health services, even when the goal is maintaining the patient’s current condition rather than requiring that the patient improving.
     The Medicare law has never supported the “improvement standard.” Nevertheless, for decades beneficiaries have been denied needed services because they are not improving or have “plateaued”, sometimes with devastating results. The Center for Medicare Advocacy says providing maintenance services will save money in the long run, preventing decline, hospitalizations and need for more expensive services.

     The official approval of the settlement means the Center for Medicare and Medicaid Services (CMS) must develop and implement an education campaign to ensure that Medicare providers are not denying coverage for vital maintenance services to those with any chronic illness who meet other qualifying Medicare requirements.
    The “maintenance standard” is effective immediately. Even though we have not seen the official documentation that Chiropractic Maintenance Care is included in this settlement, we are presently requesting a specific answer from CMS. If you or someone you are caring for has a chronic illness or needs skilled services to prevent further deterioration, contact your health provider.

Originally Posted on 02/6/2013 by Amy Goyer, see original link below:

Friday, January 11, 2013


January 11, 2013
Chiropractic Medicare

So many calls about PQRS. So many of my colleagues not taking this seriously. Becoming Medicare Compliant is a “voluntary” process they say. Let us understand what the government means by “voluntary”.

You voluntarily pay your income taxes. Oh, so you don’t have to if you don’t want to! However, your life as you now know it “will change!” The same for Medicare Compliance, becoming paperless and following the Physicians Quality Reporting System (PQRS). If you wish to be in Chiropractic practice in 2017, you better make use of this “final” window we are now in.

Who has to do this? Everyone and anyone seeing and billing Medicare patients. It’s that simple. If you adjust a Medicare patient, federal law requires you to bill Medicare within one year. You must become Medicare Compliant, use electronic billing and record keeping, and apply the PQRS Codes.

For more helpful links to information about PQRS and other Medicare related click here, or follow this address:

Thursday, January 3, 2013

2013 Fees and PQRS Information

January 2, 2013
Chiropractic Medicare
"Opening the Final Voluntary Window"

To my fellow Chiropractors.........
Congress passed, just last night, Section 1848(d) of the Social Security Act (42 U.S.C. 1395w-4(d)) that amended by adding a paragraph that updated the single conversion factor for such year shall be zero percent. In other words, our fees are the same as last year and we again escaped a nearly 24% cut in our Medicare reimbursement fees for 98940-98942. Below, find the website for your interest.

January 1, 2013 is the beginning of the final voluntary window to do PQRS. So lets talk about "voluntary " window. You can compare voluntary window with paying your income taxes. You have a voluntary time factor to pay your income taxes. If you pass up the voluntary window to pay your taxes, it is going to cost you more in the long run and you begin to lose privileges.

Now you are beginning to get the idea of "voluntary". PQRS is exactly the same. You have a choice. You can voluntarily implement the PQRS program and even receive an incentive for doing so in this final window....or you can pass this FINAL window of voluntary opportunity, don't do anything in regards to PQRS and get prepared to receive financial cuts in, not only Medicare, but nearly all insurance companies from now on.

Plus, you will begin to lose privileges of even dealing with some insurance companies and probably a dollar cap on any patient having insurance that you adjust for cash. And, since we Chiropractors can not opt out of Medicare and are required to bill Medicare for all covered services, your Medicare fees will continue to drop, making NO difference whether you are a participating or non-participating provider.

For the Chiropractor who says, "We don't do Medicare. We adjust the Medicare patient, collect cash from the patient and don't bill Medicare." Hold on for the ride! When you get caught...and you will get caught...the fines are up to $10,000.00 per adjustment. Just like not paying your income taxes.

I am guessing only about 35% of my fellow Chiropractors are prepared for PQRS. I strongly recommend, as I have for the last 18 months, BITE THE BULLET and make it happen NOW!

Here are some helpful links about PQRS: