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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: