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.
Chiropractic Medicare Articles & Resources Articles
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The OIG Work Plan: What Is It and Why Should I Care?
August 9th, 2019
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 ...
Q/A: What do I Need to Document for Periodic Adjustments on a Medicare Patient?
July 22nd, 2019
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 ...
Act Now on CMS Proposal to Cover Acupuncture for Chronic Low Back Pain
July 17th, 2019
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.
Medicare Supplemental Policies (MediGap) and Extremity Adjustments
February 25th, 2019
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 ...
Q/A: Can a PT Assistant Perform Physical Therapy Modalities?
June 18th, 2018
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.
Medicare Requiring Specific Modifiers on Therapy Services
January 15th, 2018
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 ...
Billing with a GP Modifier
January 15th, 2018
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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Chiropractic Medicare Articles & Resources Tips
Chiropractic Medicare Articles & Resources Webinars
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Chiropractic Manipulative Treatment and Medicare - Part 2
December 11th, 2018
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.
Proving Medical Necessity and Functional Improvement
October 11th, 2017
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.
2018 Coding and Documentation Issues
September 1st, 2017
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.
How to Report MIPS
September 11th, 2017
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.
The New Local Coverage Determinations and What They Mean to You
August 8th, 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. 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
How to Convert Your Medicare Patients to Cash to Avoid the Penalties of MACRA
May 11th, 2017
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
Medicare Subsequent (daily) Visit Documentation
May 10th, 2017
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.
The NEW “Episodic Care” Concept in Medicare
April 12th, 2017
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.
Medicare Initial Visit Documentation
April 12th, 2017
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
How to Check NCCI Edits Using FindACode
January 15th, 2019
How to Check NCCI Edits Using FindACode
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