Seminar in February 2019

New Seminar date!

Date: Thursday, February 21, 2019 Cancelled
Time: 1:00 PM - 5:00 PM
Location: O'Fallon, Illinois
Location address:
 Hilton Garden Inn O'Fallon

For questions please call: (618) 395-3162

Seminars in Washington and Oregon

Date: Saturday, November 4, 2017

Time: 8:30 AM - 12:30 PM

Location: Portland, Oregon

Location address:

 Radisson Hotel Portland Airport

 6233 NE 78th CT

 Portland, OR 97218

Hotel phone: (503) 251-2000 for direction purposes only

To register or for questions please call: (618) 395-3162

Date: Thursday, November 2, 2017

Time: 8:30 AM - 12:30 PM

Location: Pacific, Washington

Location address:

 Quality Inn & Suites

 415 Ellingson Road

 Pacific, WA 98047

Hotel phone: (253) 288-1916 for direction purposes only

To register or for questions please call: (618) 395-3162

Open Enrollment and ICD-10

Newsletter

December 11, 2014

Chiropractic Medicare

"Open Enrollment and ICD-10"

 

2015 Medicare Participation Enrollment period is open, running from mid-November through January 31, 2015. This Open Enrollment Period gives Medicare Providers the opportunity to change their participation status. You can also access your new 2015 Medicare Fee Schedule by going to your carrier’s website.

If you choose to change your Medicare Participation status, you can do so with a certified letter to your Medicare Carrier indicating your change in the Medicare Part B Program effective January 2015. (Those in possession of our Chiropractic Medicare DVD and booklet, see example letter page 42 in booklet.)

CMS has released their final ICD-10 rule, indicating implementation of ICD-10 will occur October 1, 2015 with no further delays.

The implementation of ICD-10 will require us to change the way we called patient data and document in our charts. The change that must occur deals with being more “specific” to the highest degree. The more specific the data collecting and documentation the easier it will be to find the correct ICD-10 code. If you are using a certified software with all of its parts, when your data collecting is complete, your software should be able to do the conversion automatically from ICD-9 to ICD-10. Please make sure to communicate with your certified software company about getting the new ICD-10 codes and training for correct use.

Insurance companies are determining, with clarification from CMS, which specific codes are to be used and acceptable by providers. The key will be specific data collecting on all preliminary forms so that your software can either do the conversion or prompt you for more specificity to choose the correct ICD-10 code. DO NOT WAIT to review your data collecting for “specific” information. If you wait until October 2015 you could have a long spell of no commercial insurance or Medicare reimbursement.

Remember, while preparing for ICD-10 implementation, we must still be doing Medicare correctly. Also, doing Electronic Health Records or “EHR” (being paperless) is only one part of the seven steps necessary to become Medicare Compliant. You can either write your own Medicare Compliance Policy Book activating the requirements in your office, or you may purchase a Medicare Compliance book like you did with HIPAA.

No Out-of-pocket, PECOS, CMS-855i, Fees

Newsletter
November 9, 2011
Chiropractic Medicare

Dear Doctors and Staff,

1.  No Out-of-pocket Expense - Medicare
2.  CMS 855i or PECOS
3.  Medicare Fees

1.  It is against the law to practice No Out-Of-Pocket expense in Medicare.  If you are a participating provider, you have signed a contract with the Federal Government that you will "accept assignment" on ALL Medicare patients.  The Medicare reimbursement of 80% always comes to the doctor.  However, the doctor MUST collect the other 20% from either the patient or the patient's supplemental insurance.  Only accepting the 80% of what Medicare pays is called No Out-Of-Pocket expenses, which is a breach of Medicare law.

2.  CMS 855i Application or PECOS must be completed by All Chiropractors.  If you have not gone on line and completed PECOS or downloaded CMS 855i off the CMS website and completed...DO IT NOW!  If you do not, there will be NO Medicare reimbursement in the near future.

3.  Our Medicare fees have been posted for 2012.  All have been decreased by about 21%.  We again wait on Congress to move on this issue, the same as earlier this year.  With any luck, we may have our fees restored with minimal increases over 2011.

Understanding Medicare "Replacement" Plans ~Newsletter October 24, 2011

Newsletter
October 24, 2011
Chiropractic Medicare
Understanding Medicare "Replacement" Plans

Dear Doctors and Staff,

Nothing is "simple" including Medicare replacement plans.  The Medicare Carriers are losing "customers" to these plans and are not happy with them.

Just so you know....there are two kinds of replacement plans:

1. Plans that subcontract...in other words, the patient of this plan is still on a contract with Medicare and is still with Medicare.  Which means....when we see this patient in our Chiropractic office, we must follow ALL the Medicare guidelines, even when billing the replacement plan.  Even if the replacement plan has a $35.00 co-pay, we must still bill.
2. If your patient has a "Medicare replacement" and the patient has bailed out of  Medicare and not paying Medicare premiums each month, this person is now in the same category as the rest of your patients.  You do not have to bill the replacement insurance and your fees are the same as your non-Medicare patients....Unless....you bill this replacement insurance one time.  Now you are on contract with the Medicare replacement insurance company to follow ALL the Medicare guidelines, fees and billing. Even though the replacement company has a $35.00 co-pay, and pays nothing on the claims, you must file for your patient.

IMPORTANT:  If your patient tells you they have a Medicare replacement program, you must call your "Medicare Carrier", not the replacement insurance, and ask if your patient is in the federal "Medicare" program or not.  The answer is either yes or no.  You will then know who, what and where to bill.

Quitting Medicare

First of all, you must understand that if you continue to provide the payable service of 98940, 98941 or 98942 to any patient that has Medicare coverage, you cannot "Quit" or disassociate yourself from the Medicare Program. 

The only way to avoid the Medicare rules is to provide your covered services for "free" to the Medicare patient, or refer them to other offices that accept Medicare. If you have a Medicare Provider Number, that means you signed a contract giving you privilege to provide Chiropractic adjustments for Medicare consumers, and that you will know and follow all Medicare guidelines.

Chiropractors cannot "OPT-OUT" of Medicare.  You can either adjust Medicare patients and follow the guidelines or provide "free" adjustments or not adjust Medicare patients. How do you get out of paying taxes? You don't. Remember: Medicare is a U. S. Government Program.  Do it correctly or don't do it at all!

If you are correcting vertebral subluxations that is a covered service in Medicare. When you provide a covered service, you must bill Medicare in a reasonable amount of time, one year or less.  Both participating and non-participating providers must collect the 20 % not paid by Medicare, from your patient or their supplemental insurance.  It is against the law to practice "NO out of pocket expenses" with Medicare.

Chiropractic Medicare Fees and Collecting Payment

Dear Doctors and Staff,

Chiropractors are the only healthcare providers that CANNOT opt-out of Medicare. When you see seniors with Medicare in your practice you must do Medicare correctly!

Each Medicare carrier provides a fee schedule for the Chiropractors each year in each state local.  You can go to your Medicare Carrier's website search for Physician Fee Schedule (go to about page 245) and you will find 98940, 98941 and 98942 with specific fees for your local for both participating and non-participating providers.  The code with the # sign indicates the fees set for if you adjust this patient in another facility other than your office. The fees without the # sign are your in-office fees.

Participating providers may bill the Medicare Carrier whatever fee they wish.  The Medicare Carrier has the responsibility to know your Medicare fees and will automatically reimburse to the DC 80% of those fees.  The Chiropractor must collect the 20% from the patient or supplemental insurance and NEVER collect from any payor above the set fees by the Medicare Carrier. If you do, and get caught, the fines are up to $10,000.00 per incident.

A non-participating provider must know what the Medicare fees are prior to seeing or billing either the Medicare patient or the Medicare Carrier.  If they don’t and get caught, they may be fined up to $10,000.00 per incident and the same for being paid above the set Medicare fees.  The non-participating provider must never collect or bill any payor above the "limiting" charge, including a Medicare patient in auto accidents, worker’s comp., etc.