Chiropractic Medicare Articles & Resources

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:

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Billing and Documenting for Therapeutic Exercises versus Therapeutic Activities

by  Evan M. Gwilliam, DC MBA CPC CCPC CPC-I QCC MCS-P CPMA CMHP AAPC Fellow

Chiropractors treat, among other things, issues with the musculoskeletal system. Active therapeutic procedures are accepted as effective ways to treat many common conditions and therefore can be billed and generate revenue for a clinic. Two common CPT codes that might be used in a chiropractic setting include:

Is Your Organization Ready to Deal with Provider Relief Fund (PRF) Audit Contractors?

by  Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT

Audits are currently underway to verify the monies distributed through the CARES Act were warranted and properly used by those organizations that received them. The federal government has contracted with financial institutions such as KPMG and PricewaterhouseCoopers, among others, to perform these audits referred to as Provider Relief Fund (PRF) audit contractors, funded with monies from the very same program. There were four phases of funding disbursements with phase 1 audits beginning in September. How ready are you to be audited?

Watch out for New ICD-10-CM Codes

by  Wyn Staheli, Director of Content - innoviHealth

New ICD Codes for: Low Back Pain, Cervicogenic Headache, Non-Radiographic Axial Spondyloarthritis (nr-axSpA), and Social Determinations of Health (SDOH). These codes became effective on October 1, 2021.

MEGA - NCCI Edit Changes - WHO Knew?

by  Christine Woolstenhulme, QMC QCC CMCS CPC CMRS

There was no huge announcement when CMS released new files in April. The files that were released on April 7, 2020, actually replaced files to update the NCCI edits on Procedure to Procedure (PTP) edits and Medically Unlikely Edits (MUE).  The updated files included; 291,902 Deleted Procedure to Procedure (PTP) edits 197  Deleted Medically Unlikely ...

Additional Telehealth Changes Announced by CMS

by  Wyn Staheli, Director of Content - innoviHealth

On April 30, 2020, CMS announced additional sweeping changes to meet the challenges of providing adequate healthcare during this pandemic. These changes expand the March 31st changes. The article covers some of the key changes. See the official announcement in the references below.

COVID-19 Chiropractic Resources

by  Wyn Staheli, Director of Content - innoviHealth

COVID-19 Chiropractic Resources contains current, updated information regarding COVID-19. Included are lists of webinars, articles, websites and links pertaining to the ongoing changes.

Medicare Begins Covering Acupuncture Services

by  Wyn Staheli, Director of Content - innoviHealth

Medicare is changing their policy regarding coverage of acupuncture, but in order to provide these services, you must follow their rules.

CMS and HHS Tighten Enrollment Rules and Increase Penalties

by  Wyn Staheli, Director of Content - innoviHealth

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 ...

Are You Aware of Medicare Advantage Plans Timely Filing Rules?

by  Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT

The Medicare Fee for Service (FFS) program (Traditional or Original Medicare) has a timely filing requirement; a clean claim for services rendered must be received within one year of the date of service or risk payment denial. As any company who has billed Medicare services can attest, the one-year timely filing ...

The OIG Work Plan: What Is It and Why Should I Care?

by  NAMAS

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?

by  Evan M. Gwilliam, DC MBA CPC CCPC CPC-I QCC MCS-P CPMA CMHP AAPC Fellow

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

by  Wyn Staheli, Director of Content - innoviHealth

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.

Helping Others Understand How to Apply Incident to Guidelines

by  NAMAS

Over the past few months, I have worked with different organizations that have been misinterpreting the "incident to" guidelines and, in return, have been billing for services rendered by staff that are not qualified to perform the services per AMA and CPT. What I found within the variances is that ...

A United Approach

by  NAMAS

A United Approach As auditors, we all have a different perspective when evaluating documentation. It would be unreasonable to think that we all view things the same way. In my opinion, differing perspectives are what makes a great team because you can coalesce on a particular chart, work it through and ...

Medicare Revises Their Appeals Process

by  Wyn Staheli, Director of Content - innoviHealth

On April 12, 2019, Medicare announced that there will be some changes to their appeals process effective June 13, 2019. According to the MLN Matters release (see References), the following policy revisions in the Medicare Claims Processing Manual (MCPM), Chapter 29 are taking place: The policy on use of electronic signatures Timing ...

What is Medical Necessity and How Does Documentation Support It?

by  Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT

We recently fielded the question, “What is medical necessity and how do I know if it's been met?" The AMA defines medical necessity as: It is important to understand that while the AMA provides general guidance on what they consider medically necessary services, these particular coding guidelines are generic and may be ...

Clearing Up Some Medicare Participation Misunderstandings

by  Wyn Staheli, Director of Content - innoviHealth

Even though we may think we truly understand what it means to be a participating provider, Medicare doesn’t quite work the way that other insurance plans do. Far too many providers do not understand the difference and get into hot water. To further complicate matters, the rules are different for ...

The Impact of Medical Necessity on High Level E/M Services

by  Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT

I was recently asked the question, "Does 99233 require documentation of a past medical, family, and/or social history (PFSH)?"  The quick answer is, "it depends." Code 99233 has the following minimal component requirement: Subsequent inpatient E/M encounters can meet the code level requirement either by component scoring & medical necessity or time & medical necessity. ...

Q/A: Can you Help me Understand the New Medicare Insurance Cards?

by  Wyn Staheli, Director of Content - innoviHealth

As many of you are aware, CMS began issuing new Medicare identification cards last year which required the replacement of social security numbers with a new Medicare Beneficiary Identifier (MBI). All cards have now been mailed out and patient's should have the new cards when they come in. Currently, we are in the transition period until January 2020.

Understanding NCCI Edits

by  Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT

Medicare creates and maintains the National Correct Coding Initiative (NCCI) edits and NCCI Policy Manual, which identify code pair edits. When performed on the same patient, on the same day, and by the same provider, the secondary code is considered an integral part of the primary code, and payment for ...
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Select the title to see a summary and a link to the full webinar information.  some webinars require a subscription to view.

Medicare and the ABN for Chiropractic 

by  Evan M. Gwilliam, DC MBA CPC CCPC CPC-I QCC MCS-P CPMA CMHP AAPC Fellow

Medicare Audit, Do-it-yourself 

by  Evan M. Gwilliam, DC MBA CPC CCPC CPC-I QCC MCS-P CPMA CMHP AAPC Fellow

Proving Medical Necessity and Functional Improvement 

by  Ron Short, DC MCS-P CPC

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.

Inappropriate Payments Made to Chiropractors – An OIG Review 

by  Evan M. Gwilliam, DC MBA CPC CCPC CPC-I QCC MCS-P CPMA CMHP AAPC Fellow

In this webinar, Dr. Gwilliam will take you on a fun filled journey through all of the reports created by the Office of the Inspector General based on their reviews of chiropractors. If you can understand what they see, and what advice they give Medicare when dealing with chiropractors, then you will be better prepared to not become their next target. This webinar may feel a little frightening with hundreds of thousands of dollars paid back to CMS, but, by the end, you will know exactly what to do and what not to do.

Chiropractic Manipulative Treatment and Medicare - Part 2 

by  Evan M. Gwilliam, DC MBA CPC CCPC CPC-I QCC MCS-P CPMA CMHP AAPC Fellow

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.

How to Report MIPS 

by  Evan M. Gwilliam, DC MBA CPC CCPC CPC-I QCC MCS-P CPMA CMHP AAPC Fellow

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.

How to Check NCCI Edits Using FindACode 

by  Find-A-Code™

How to Check NCCI Edits Using FindACode

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