Medicare is a complex topic. For detailed information on this government program, as it relates to chiropractic services, see Chapter 2 in the ChiroCode DeskBook. The following concepts are covered in the DeskBook:
For additional information visit ChiroCode.com. Since 1993 Chiropractors have depended on ChiroCode as a reliable source of information for the Chiropractic community. Because of the dependability and education, ChiroCode has earned much renown. View current and recent webinars, order the ChiroCode DeskBook, (comprehensive go-to chiropractic reimbursement manual) and much more.
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September 30th, 2019
CMS and HHS Tighten Enrollment Rules and Increase Penalties
Published September 30th, 2019|
This ruling impacts what providers and suppliers are required to disclose to be considered eligible to participate in Medicare, Medicaid, and Children's Health Insurance Program (CHIP). The original proposed rule came out in 2016 and this final rule will go into effect on November 4, 2019. There have been known problems ...
August 9th, 2019
The OIG Work Plan: What Is It and Why Should I Care?
Published August 9th, 2019 - Last Review/Update August 14th, 2019|
The Department of Health and Human Services (HHS) founded its Office of Inspector General (OIG) in 1976 and tasked it with the responsibility to combat waste, fraud, and abuse within Medicare, Medicaid, and the other HHS programs. With approximately 1,600 employees, HHS OIG is the largest inspector general's office within ...
July 22nd, 2019
Q/A: What do I Need to Document for Periodic Adjustments on a Medicare Patient?
Published July 22nd, 2019|
Question: What type of documentation is required for a Medicare patient with degenerative joint disease who get adjusted once or twice a month for occasional flare-ups of the D. J. D. region? The noted adjustments give good relief of the patient's symptoms. Answer: There is no question that these adjustments would be considered ...
July 17th, 2019
Act Now on CMS Proposal to Cover Acupuncture for Chronic Low Back Pain
Published July 17th, 2019|
Now is the time to comment on a proposal to cover acupuncture for chronic low back pain. This comment period is the part of the HHS response to the opioid crisis. You only have until August 14th to officially comment.
February 25th, 2019
Medicare Supplemental Policies (MediGap) and Extremity Adjustments
Published February 25th, 2019|
The nice thing about MediGap policies is that they pay for some of the healthcare costs that an original Medicare plan (Part B) does not cover. So when a patient has Medicare and a Medicare supplement (MediGap) and their condition is related to an extremity (a noncovered service), Medicare must ...
June 18th, 2018
Q/A: Can a PT Assistant Perform Physical Therapy Modalities?
Published June 18th, 2018 - Last Review/Update January 30th, 2019|
Whether or not a physical therapy assistant (PTA) may perform physical therapy modalities depends on two factors: state law and payer policies. Read here for more.
January 15th, 2018
Medicare Requiring Specific Modifiers on Therapy Services
Published January 15th, 2018|
Medicare's MLN Matters Number: MM10176 was recently revised to identify services subject to their therapy cap. The revision became effective on January 1, 2018 and some providers have begun to receive claim rejections because they are not using the appropriate modifier. The article states the following: Services furnished under the Outpatient ...
January 15th, 2018
Billing with a GP Modifier
Published January 15th, 2018 - Last Review/Update January 30th, 2019|
Q: When patients have a true Medicare secondary insurance we've always billed other Medicare non-covered codes such as G0283 for electric stimulation with modifier GY because we are aware Medicare will not pay for that service but the secondary insurance does. We just were notified by our MAC that GY is not a valid modifier and I have to enter a GP or other therapy modifier. What is the new proper modifier to enter?
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December 11th, 2018
Chiropractic Manipulative Treatment and Medicare - Part 2
In this CE webinar, Dr. Gwilliam will continue his discussion from the webinar delivered Dec. 18 about chiropractic manipulative treatment. But this time, it is all about Medicare. If you don't treat Medicare beneficiaries, you should probably listen anyway. Usually whatever Medicare wants is the same thing as all the other payers. Find out the difference between acute, chronic, and maintenance, as well as when to use certain modifiers.
October 11th, 2017
Proving Medical Necessity and Functional Improvement
Medicare is required by law to pay for care that is medically necessary. Medicare considers functional improvement to be the primary indicator of medical necessity for chiropractic care. It is up to you, the doctor, to prove functional improvement and medical necessity with your documentation. Dr. Short will show you how to use common practice tools to document functional improvement, medical necessity and maximum medical improvement. You will learn: What is Medicare’s definition of medical necessity. How to prove medical necessity. How to report this information to Medicare. How to determine Maximum Medical Improvement.
September 11th, 2017
Earlier this year the Medicare Administrative Contractors revised their Local Coverage Determinations. There are some changes that will affect how you document your Medicare visits. Medicare requires that you have a treatment plan with measurable goals. The treatment plan also serves the purpose of providing you and your patient with a roadmap of care. In this webinar Dr. Short will show you: What specific elements Medicare requires in each treatment plan. How to use common clinical tools to develop effective treatment plans. Why the treatment plan is critical to proving medical necessity and overall patient care. This webinar will give you practical information that you can apply in your office the next day. You can obtain the notes for this webinar by subscribing to my e-mail updates at http://www.chiromedicare.net/mailing-list- signup/ or by following the link provided in my e- mail update. They will be available by the Monday prior to the webinar presentation.
September 1st, 2017
2018 Coding and Documentation Issues
In this webinar, Dr. Gwilliam will go over code updates for 2018. He will show you some new ways to look at Episodes of Care, which is critical for Medicare. You'll learn how to use self audit checklists to make sure you survive the inevitable third party audit. Confession: This webinar is really just a pitch for all of the cool new things we are adding to the 2018 DeskBook, which will be released in October. We will give you the low down on what you need to be successful next year.
September 11th, 2017
How to Report MIPS
If eligible, you need to start reporting for MIPS by October 2th, 2017. Do you know who is exempt? Are you familiar with the quality measures that apply to chiropractors? Do you understand how to report on the Advancing Care Information or Improvement Activities? Don’t worry, Dr. Gwilliam has done all your homework and, in this presentation, you will get the crib notes containing just what you need to know. You don’t need to feel overwhelmed with Medicare regulations, you just need to know what to do.
August 8th, 2017
The New Local Coverage Determinations and What They Mean to You
Earlier this year the Medicare Administrative Contractors revised their Local Coverage Determinations. There are some changes that will affect how you document your Medicare visits. In this webinar, Dr. Ron Short will explain the changes to the Local Coverage Determinations and how to utilize them in your practice. You will learn: What has changed and how it will affect you What has stayed the same How to document Medicare Visits
May 11th, 2017
How to Convert Your Medicare Patients to Cash to Avoid the Penalties of MACRA
The #1 concern reported by CMS about chiropractors is that, as a profession, we do a poor job of understanding maintenance care. Of course, that is THEIR definition of maintenance care. When you better understand the rules of medical necessity in Medicare, you begin to see what they are talking about. The truth is that there is a “gray” area between the distinct “white” of active treatment and the “black” of maintenance treatment, and that gray area is confusing when defining “covered” vs. “not covered” chiropractic care in Medicare. Join us to find out the following critical information in time for the MACRA Section 514 implementation January 1, 2017: Find out exactly what Medicare deems as maintenance care and how to recognize it with our patients Learn what your options are for treating your Medicare patient’s maintenance care for cash Hear scripting that is vital to your patient understanding what’s going on with their coverage, or lack thereof Properly document the difference between active and maintenance care Better manage those little incidents that come up for chronic, Medicare patients
May 10th, 2017
Medicare Subsequent (daily) Visit Documentation
Medicare has increased their review of chiropractors recently. What are they looking for? Medicare regulations are specific in what they want in your documentation. In the second of this two part series Dr. Ron Short will review the regulations regarding the subsequent (daily) visit documentation and translate them into practical actions that you can take in your office. In this webinar you will learn: What Medicare needs to see documented during the daily visit How to best capture the required information What element to have on each visit When to re-examine the patient. You can obtain the notes for this webinar by subscribing to my e-mail updates at http://www.chiromedicare.net/mailing-list- signup/ or by following the link provided in my e-mail update. They will be available by the Monday prior to the webinar presentation.
April 12th, 2017
The NEW “Episodic Care” Concept in Medicare
Recently, Medicare stated that they expected chiropractic care to be “episodic” in nature. Find out what Medicare expects from your treatment plan to justify medical necessity. How many treatments is too much? What are they looking for in your care? Medicare and ICD-10 Guideline changes in 2017 have resulted in massive audits taking place across the country. Many calls are coming in pertaining to denials and audits. Most are because the doctor and staff are unaware of the regulation changes. Mario Fucinari, DC, CCSP, CPCO, MCS-P, MCS-I is uniquely qualified as being still in active practice, a Certified Medical Compliance Specialist, Certified Compliance Officer and a member of the Carrier Advisory Committee.
April 12th, 2017
Medicare Initial Visit Documentation
Medicare has increased their review of chiropractors recently. What are they looking for? Medicare regulations are specific in what they want in your documentation. In the first of this two part series Dr. Ron Short will review the regulations regarding the initial visit documentation and translate them into practical actions that you can take in your office. In this webinar you will learn: -What Medicare needs to see documented during the initial visit -How to best capture the required information -What you need to make a good treatment plan -When to start a new episode of care
January 15th, 2019
How to Check NCCI Edits Using FindACode
How to Check NCCI Edits Using FindACode
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Advanced Beneficiary Notice of Noncoverage (ABN) Form Instructions ToolBreach Notification Rule by HHSChiroCode Online Fee CalculatorCMS Complying with Medicare Signature Requirements Fact SheetCMS Innovation home pageCMS Recovery Audit Program - Center for Medicare & Medicaid ServicesCMS Report: "CMS Should Use Targted Tactics to Curb Questionable and Inappropriate Payments for Chiropractic ServicesContinued Use of Modifier 59 after Jan 1, 2015Durable Medical Equipment (DME) Medicare Administrative Contractor (MAC) JurisdictionsDurable Medical Equipment Center (DME) - by CMSFAQ on the use of the AT and GA modifiers togetherHIPAA: Health Insurance Portability and Accountability Act by AMAHow to use the Medicare National Correct Coding Initiative (NCCI) Tools by MLNInappropriate Medicare Payments for Chiropractic Services Report - by the OIGIs your Office Listed on the PECOS Listing?Link to CMS Form - Request For Medicare Hearing by an Administrative Law JudgeLink to CMS Form - Request for Review of Administrative Law Judge (ALJ) Medicare Decision/DismissalLink to CMS Form - Transfer of Appeal RightsMarketing to Medicare Beneficiaries - by MedicareMeasure-Applicability Validation (MAV) CourseMedicare Advantage Plans: Cost Sharing LimitsMedicare and Medicaid Programs; Modifications to the Medicare and Medicaid Electronic Health Record (EHR) Incentive Program for 2014 and Other Changes to the EHR Incentive Program; and Health InformatMedicare Appeals ChangesMedicare Benefit Policy Manual, Chapter 15 (also known as Medicare Carriers Manual)Medicare Claims Processing Manual, Chapter 12Medicare Electronic Claims Exemption - by CMSMedicare Prospective Payment System — General InformationMedicare Reconsideration RequestMedicare Recovery Audit by HHS Office of the Inspector GeneralMedicare Secondary Payer fact sheet by CMSMedicare: To Participate or Not to Participate?Misinformation about Chiropractic Services - by Medicare Learning NetworkNational Supplier Clearinghouse home pageNCCI Instructions for Modifier 59NPI RegistryNPRM Quality Payment Program Fact SheetPQRS FAQs - by the American Chiropractic AssociationPress release: New CMS rule allows flexibility in certified EHR technology for 2014Reminder to Stop Billing Duplicate Claims by Medicare Learning NetworkSpecial Advisory Opinion 12-21 , Offering Gifts and Other Inducements (2013)- by the Office of the Inspector General (OIG)The CMS eHealth Initiative
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