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.
Showing posts with label ABN. Show all posts
Showing posts with label ABN. Show all posts
Friday, July 26, 2013
Tuesday, March 12, 2013
ABN Electronic
Newsletter
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
http://www.cms.gov/BNI/02_ABN.asp
The ABN or Advanced Beneficiary Notice of Noncoverage information
http://www.cms.gov/MLNProducts/downloads/ABN_Booklet_ICN006266.pdf
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
http://www.cms.gov/BNI/02_ABN.asp
The ABN or Advanced Beneficiary Notice of Noncoverage information
http://www.cms.gov/MLNProducts/downloads/ABN_Booklet_ICN006266.pdf
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.
THE ABN
It has become my conclusion the ABN in it’s origination has but one primary purpose....to 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.
Tuesday, April 10, 2012
"Think Like a Chiropractor"
Newsletter
April 9, 2012
Chiropractic Medicare
"Think Like a Chiropractor"
Dear Doctors and staff,
Many times, when speaking of Medicare, HIPAA, or becoming "compliant" in Medicare, it comes off as a "negative" and a "downer".
Most people have no idea the Medicare Chiropractic section was written by Chiropractors Dr. Bill Day of Washington , Dr. Bob Hulsebus of Illinois
“If we do Chiropractic Medicare as Chiropractors instead of acting like another health discipline, as your Medicare Carriers want you to be, you will have little to no problem with Medicare.”
The Chiropractic Medicare guidelines do not say we are reimbursed for "treating" our patient’s symptoms. It says we are only paid in Medicare for “correcting a vertebral subluxation”.
The vertebral subluxation is the only "covered service" in Medicare for Chiropractors. The vertebral subluxation is "always" a covered service in Medicare; however, it may not be a payable service if we cannot document the Chiropractic necessity of care. It is always the covered service which is the reason we must bill all Chiropractic adjustments to correct a vertebral subluxation. For the patient to mark Option #2 on the ABN, calling it maintenance care when the Chiropractor corrects a vertebral subluxation, is very questionable and dangerous. The adjustment to correct a vertebral subluxation is the only covered service in Medicare and must be billed within one year.
For the Chiropractor to call the Chiropractic adjustment to correct a vertebral subluxation "maintenance care," patient signs Option 2 on the ABN, creates several problems.
- The patient pays a monthly premium in Medicare for the healthcare that will not reimburse the patient if the Chiropractor does not bill or bill correctly. The patient is cheated.
- When a Chiropractor provides a covered service (98940, 98941 or 98942) in Medicare, they are required to bill Medicare within one year. You may call it Maintenance Care, however, if you corrected a vertebral subluxation that is a "covered service" and should be billed and documented for Medicare reimbursement.
- Just because a patient has NO obvious symptoms does not make this "maintenance care." The patient may be on seven (7) prescription drugs and feel no symptoms.
- When a patient has a "vertebral subluxation", they must have a related "Neuronal Component" or it is not a Subluxation.
- Example...Subluxation of T6 with the neuronal trajectory of T6 spinal nerve to the stomach altering the function of the stomach. They are probably on three prescription drugs for a stomach problem from their MD.
Think and be a Chiropractor in Medicare. That is how the Medicare Program was developed in 1973.
Do you know the importance of learning the correct way to do Medicare by federal standards and becoming Medicare Compliant?
Have questions? Give Dr. Street a call today at (618) 395-3800.
Spring 2012 Seminar Schedule:
*Thursday, April 19, 1:00 pm - 5:00 pm at the Chariot Hotel - Louisville , KY
*Thursday, May 24, 8:30 am - 12:30 pm at King Oscar Hotel
*Thursday, May 24, 6:00 pm - 10:00 pm at Staybridge Suites, Mukilteo , WA
To Register Call: (618) 395-3800
Friday, October 7, 2011
Chiropractic Maintenance Therapy (Medicare Terminology)
Newsletter
October 3, 2011
Chiropractic Maintenance Therapy (Medicare Terminology)
Under the Medicare program, Chiropractic 'maintenance therapy' is not considered to be medically reasonable or necessary, and is therefore not payable. 'Maintenance therapy' is defined as a "treatment plan" that seeks to prevent disease, promote health, and prolong and enhance the quality of life; or "therapy" that is performed to maintain or prevent deterioration of a chronic condition.
When further clinical improvement cannot reasonably be expected from continuous ongoing care, and the Chiropractic treatment becomes supportive rather than corrective in nature, the treatment is then considered "maintenance therapy". Chiropractic "maintenance therapy" is in direct relation to you as a Chiropractor, either "correcting" vertebral subluxations (vertebral displacements) or "treating" the patient's symptoms.
The Chiropractic Medicare program ONLY reimburses for a Chiropractor to correct vertebral subluxations. Patients symptoms help Chiropractors locate the causal subluxation, but are not the indicator as to if the subluxation has been corrected.
The Chiropractic adjustment is NOT a "treatment". The Chiropractic adjustment is a "correction". A "treatment" becomes supportive rather than corrective in nature, the treatment is then considered maintenance therapy.
The correction of a vertebral subluxation is the only payable service in Medicare for Chiropractors.
Many Chiropractors have fallen for the "treatment" of symptoms in Medicare....the patient marks option #2 on the ABN and Medicare is not billed. The patient has been cheated from Medicare coverage because the Chiropractor is "treating symptoms". Even though vertebral subluxations are being found and adjusted, since the patient had NO symptoms, the doctor now believes it is maintenance care. (The Medicare patient is probably on 10 prescription drugs from the local MD, and can't feel any symptoms.)
If the patient has vertebral subluxations, then there must be "Neuronal Components" or there is NO subluxation. If the patient has NO symptoms, then a thorough examination of this patient will indicate the prescription drugs the patient consumes for specific symptoms related to malfunction of specific body organs.
Matching the vertebral subluxations to a specific malfunction organ is simple for a Chiropractor.
Locating the subluxation, finding the Neuronal Component to a malfunctioning body organ must be documented by Federal standard "documentation". This is the way Chiropractic Medicare functions, like real Chiropractors, and not treating patient symptoms.
October 3, 2011
Chiropractic Maintenance Therapy (Medicare Terminology)
Under the Medicare program, Chiropractic 'maintenance therapy' is not considered to be medically reasonable or necessary, and is therefore not payable. 'Maintenance therapy' is defined as a "treatment plan" that seeks to prevent disease, promote health, and prolong and enhance the quality of life; or "therapy" that is performed to maintain or prevent deterioration of a chronic condition.
When further clinical improvement cannot reasonably be expected from continuous ongoing care, and the Chiropractic treatment becomes supportive rather than corrective in nature, the treatment is then considered "maintenance therapy". Chiropractic "maintenance therapy" is in direct relation to you as a Chiropractor, either "correcting" vertebral subluxations (vertebral displacements) or "treating" the patient's symptoms.
The Chiropractic Medicare program ONLY reimburses for a Chiropractor to correct vertebral subluxations. Patients symptoms help Chiropractors locate the causal subluxation, but are not the indicator as to if the subluxation has been corrected.
The Chiropractic adjustment is NOT a "treatment". The Chiropractic adjustment is a "correction". A "treatment" becomes supportive rather than corrective in nature, the treatment is then considered maintenance therapy.
The correction of a vertebral subluxation is the only payable service in Medicare for Chiropractors.
Many Chiropractors have fallen for the "treatment" of symptoms in Medicare....the patient marks option #2 on the ABN and Medicare is not billed. The patient has been cheated from Medicare coverage because the Chiropractor is "treating symptoms". Even though vertebral subluxations are being found and adjusted, since the patient had NO symptoms, the doctor now believes it is maintenance care. (The Medicare patient is probably on 10 prescription drugs from the local MD, and can't feel any symptoms.)
If the patient has vertebral subluxations, then there must be "Neuronal Components" or there is NO subluxation. If the patient has NO symptoms, then a thorough examination of this patient will indicate the prescription drugs the patient consumes for specific symptoms related to malfunction of specific body organs.
Matching the vertebral subluxations to a specific malfunction organ is simple for a Chiropractor.
Locating the subluxation, finding the Neuronal Component to a malfunctioning body organ must be documented by Federal standard "documentation". This is the way Chiropractic Medicare functions, like real Chiropractors, and not treating patient symptoms.
Wednesday, September 7, 2011
NEW Advance Beneficiary Notice of Non-Coverage (ABN) CMS-R-131(03/11)
NEW Advance Beneficiary Notice of Non-Coverage (ABN)
The centers for Medicare and Medicaid Services (CMS) has released a revised Advance Beneficiary Notice of Non-Coverage (ABN) CMS-R-131 form, http://www.cms.gov/BNI/02_ABN.asp. The ABN is issued by providers where, depending upon a situation, Medicare payment is expected to be denied. That includes a covered service in which the doctor believes Medicare will not pay and all non-covered services billed to Medicare.
That also includes referral of a Medicare patient for any service by another health care provider including a covered service.
NOTE: The only differences found on this revised ABN and the prior is the date of issue on the bottom of the form. CMS-R-131(03/11)
This specific form has a mandatory use date of November 1, 2011.
Option # 2 is the primary change from the original ABN. Please keep in mind, Option #2 is used ONLY for non-covered service. Taking a covered service as 98940, 98941 or 98942, calling it maintenance care, with the patient checking Option #2 and not billing the Medicare Carrier for the Chiropractic adjustment is "thin ice" maneuvering.
The Chiropractic adjustment is the only reimbursable service for Chiropractors. When a Chiropractor adjusts a patient to correct a vertebral subluxation, then that is a covered service in Medicare not maintenance care.
The doctor must learn to honestly and specifically "document" the Chiropractic necessity of care by "federal standards." The patient who has a subluxation has had either an accident, exacerbation, or a specific "Neuronal Component". It is the doctors job to prove the subluxation, document the cause of subluxation, and correct the subluxation with an adjustment. That is a covered service by Medicare.
The centers for Medicare and Medicaid Services (CMS) has released a revised Advance Beneficiary Notice of Non-Coverage (ABN) CMS-R-131 form, http://www.cms.gov/BNI/02_ABN.asp. The ABN is issued by providers where, depending upon a situation, Medicare payment is expected to be denied. That includes a covered service in which the doctor believes Medicare will not pay and all non-covered services billed to Medicare.
That also includes referral of a Medicare patient for any service by another health care provider including a covered service.
NOTE: The only differences found on this revised ABN and the prior is the date of issue on the bottom of the form. CMS-R-131(03/11)
This specific form has a mandatory use date of November 1, 2011.
Option # 2 is the primary change from the original ABN. Please keep in mind, Option #2 is used ONLY for non-covered service. Taking a covered service as 98940, 98941 or 98942, calling it maintenance care, with the patient checking Option #2 and not billing the Medicare Carrier for the Chiropractic adjustment is "thin ice" maneuvering.
The Chiropractic adjustment is the only reimbursable service for Chiropractors. When a Chiropractor adjusts a patient to correct a vertebral subluxation, then that is a covered service in Medicare not maintenance care.
The doctor must learn to honestly and specifically "document" the Chiropractic necessity of care by "federal standards." The patient who has a subluxation has had either an accident, exacerbation, or a specific "Neuronal Component". It is the doctors job to prove the subluxation, document the cause of subluxation, and correct the subluxation with an adjustment. That is a covered service by Medicare.
Wednesday, August 17, 2011
Other Payers on a Medicare Patient
There are specific guidelines we all must know and follow as we see Medicare patients that have another primary payer other than Medicare. (e.g., Workers Comp., Auto Insurance, Personal Injury, etc.) Keep in mind, we are required to bill Medicare for ALL covered services even if there is another payer.
As a Participating Provider, you may bill your normal PI fees on this Medicare patient to all other payers and collect above the Medicare fees from other payers.
Non-participating Providers, even though they receive the highest reimbursement from Medicare (i.e. the limiting charge), you must NEVER bill or collect from any payer on this Medicare patient above the limiting charge. (The limiting charge is the amount your Medicare carrier has set for your local.) Item 10a through 10c on the claim form or in the electronic billing format will tell the Medicare Carrier (and other payers) who is responsible for payment.
Make a copy of the claim to the primary payer other than Medicare e.g., Workers Comp., Auto Insurance, Personal Injury, etc., and also, send a copy of the claim to the Medicare Carrier. Be sure when billing another payer on this Medicare patient, to have the patient sign an ABN each visit, for both covered and non-covered services and use all modifiers, since Medicare will not pay. (Example: 98941 AT GA)
The advantage of billing Medicare on this PI claim is if the PI claim fails and your patient loses the case, now Medicare will pay most of the claim because it was billed within the year time limit with all the correct modifiers and fees.
Questions? Give me a call today at 1-800-MY CHIRO.
Sincerely,
Dr. Street
As a Participating Provider, you may bill your normal PI fees on this Medicare patient to all other payers and collect above the Medicare fees from other payers.
Non-participating Providers, even though they receive the highest reimbursement from Medicare (i.e. the limiting charge), you must NEVER bill or collect from any payer on this Medicare patient above the limiting charge. (The limiting charge is the amount your Medicare carrier has set for your local.) Item 10a through 10c on the claim form or in the electronic billing format will tell the Medicare Carrier (and other payers) who is responsible for payment.
Make a copy of the claim to the primary payer other than Medicare e.g., Workers Comp., Auto Insurance, Personal Injury, etc., and also, send a copy of the claim to the Medicare Carrier. Be sure when billing another payer on this Medicare patient, to have the patient sign an ABN each visit, for both covered and non-covered services and use all modifiers, since Medicare will not pay. (Example: 98941 AT GA)
The advantage of billing Medicare on this PI claim is if the PI claim fails and your patient loses the case, now Medicare will pay most of the claim because it was billed within the year time limit with all the correct modifiers and fees.
Questions? Give me a call today at 1-800-MY CHIRO.
Sincerely,
Dr. Street
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