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 years...now 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 unless....you 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.
NOVEMBER SEMINAR
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
Wednesday, October 23, 2013
Newsletter from 10/15/2013
Newsletter
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.
***** So...be 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.
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.
***** So...be 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
Newsletter
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 exacerbations. An 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).
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 exacerbations. An 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).
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