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MEDICAL BILLING NEWS
Certainly you need to consult with the Medicare Website for the particulars, but here is a simple rendering of what the new ABN is all about:medical billing
The new ABN form will be mandatory for all Medicare Providers beginning March 1, 2009. medical billing
ABN: Advance Beneficiary Notice is designed to protect the Medicare provider as well as the patient. If the patient signs the ABN form and you send a claim to Medicare and they, for any reason, refuse to pay, you can then turn to the patient for payment. You will have a written and signed document protecting your financial rights to payment. It is also good for the patient because he/she is fully informed on what they can expect from you and from Medicare as far as their financial obligations are concerned. medical billing
We have 2 forms for you to download on this page. These particular forms are modified so you can add your Practice name, address and telephone number (required on the ABN) yet they are fully compliant and originated from the ChiroCode Institute, Phoenix, Arizona. You can find the ChiroCode link on the Resources page. chiropractic billing
One form is for the Medicare (only) patient to sign when they come in for the first time to receive X-Rays and Exam. Medicare will not cover these services and the patient needs to be informed of that. Whatever your prices are, do not write anything on the form that will be seen as a “discount” or any form of inducement over $10.00 to get them in the office as a patient. Medicare is very clear that if there is any evidence of inducement over the value of $10.00, then the practitioner is committing insurance fraud. We have some Doctors that do offer coupon discounts, but because of the Medicare rule, they are very careful NOT to offer these discounts to Medicare patients. chiropractic billing
Fill in the patient’s name and you can use any inter-office ID number in the identification number space.
In the SERVICE box, write down "X-Ray" and "Exam" and maybe even "Therapy." Under REASON, you can state "Not covered" or "Non covered service." You need to put in an estimated cost. Only one cost needs to be put in that box, as it can cover all of the services listed. Also, the words “Non covered service” only needs to be listed once as it will apply to all of the services listed. chiropractic billing
OPTIONS
Most patients will go for Option #1. They want the service and they want it billed to Medicare and they understand that if Medicare does not pay, they are liable for payment. chiropractic billing medical billingOption #2: They want the service, but do not bill Medicare. You can bill another insurance company if they have another Primary carrier, or at that point they become a Cash Case. chiropractic billing medical billing
Option #3 says they are not interested in being one of your patients! They do not want treatment, and they will not pay for it anyway. chiropractic billing medical billing
What to do when they choose option #1:
Find out if they have secondary or supplemental insurance. Supplemental insurance will pick up the patient’s co-pay, whereas secondary insurance might pay for some of the services that Medicare does not pay, as well as the deductible. chiropractic billing medical billing
You can follow this procedure even if they do not have secondary, so just to keep things simple: Bill everything that the Doctor does. Bill it to Medicare even if Medicare does not pay, because the patient may have a secondary insurance that might pay for some of the non-covered services. chiropractic billing medical billing
Medicare covers the CMT codes 98940, 98941 and 98942. Always add the AT modifier, which denotes Active Treatment. This is all that Medicare covers! chiropractic billing medical billing
After the first visit, you can, as an example, bill 72010, which is Full Spine X-Ray. X-Ray and Exam is not covered by Medicare, so you will add the GY modifier, which means “non covered service.” If the Doctor does an adjustment on the same visit as the exam, then bill the exam code 99203 with a 25 modifier as well as the GY modifier. If the Doctor does not do an adjustment, then bill 99203 GY.
Added note: If the patient receives therapy, bill it with a GP as well as a GY modifier. GP means “therapy.” See this example: 97140 GP GY chiropractic billing medical billing
Have the patient sign and date the form, and if their handwriting is illegible, have the patient print their name also. Make a copy for your patient. Put your copy in the patient's file. chiropractic billing medical billing
The second form is for Maintenance care. This is after they have gotten many treatments and are as good as they are going to get and want to continue receiving the adjustments to keep them from reverting back to the uncomfortable state they were in before treatments started. Have the patient sign this form before maintenance starts.
Medicare will not pay for maintenance care, but once again, if the patient has a good secondary insurance, the secondary may pay. This form is the same as the first one, just modified to fit the Maintenance situation.
If they choose option #1, we will continue to bill Medicare, but will not add the AT modifier. If a chiropractic adjustment code does not have the AT modifier on it, that means it is Maintenance care. You can bill out everything that the Doctor does, and if they have a good secondary insurance carrier, you may get some payment, but not from Medicare.
Do not put the GY modifier on the CMT codes. Leave off the AT modifier, and put a GA modifier instead. GA means that there is a signed ABN form on file.
If they choose option #2, then you do not have to bill Medicare. This form will be good for one year from the date signed. If after one year the patient is still coming in and is getting maintenance care, he/she will need to sign another form.
Once again, have them sign and date the form, give them a copy and file yours in the patient’s file.
If you have any questions, feel FREE to email or call me, Deb Tru, for further clarification and simplification.
Click on the link below to download the first form, for Non Covered Service:
PDF of ABN non-covered services, you can edit it to fit your practice
Click on this link below to download the second form, for Maintenance Care:
PDF of ABN Maintenance, you can edit it to fit your practiceChiropractic Billing * Chiropractic Billing * Chiropractic Billing
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Congress Approves Medicare Payment Patch, Provides 2.2 Percent Update
CMS Issues New Guidance to Medicare Contractors
By News Staff
6/25/2010
Congress has passed and President Obama has signed a physician payment measure that will rescind a 21.3 percent reduction in the Medicare payment rate and provide a 2.2 percent increase in Medicare payments until Nov. 30.
The Senate passed the payment measure as part of a standalone bill on June 18, and the House followed on June 24, approving a measure that rescinds the reduction in the Medicare payment rate. That reduction technically went into effect on June 1, but CMS instructed its contractors to hold claims until June 18.
The payment patch will apply retroactively to claims for services provided on or after June 1. The legislation also provides a 2.2 percent update in the Medicare payment rate until Nov. 30, effectively blocking cuts called for by the sustainable growth rate, or SGR, formula for the next five months.
"Although today's vote provides a reprieve from ruinous pay cuts that threaten the financial viability of primary care physicians' practices and -- therefore -- their patients' access to care, it is not a satisfactory way to provide long-term stability to Medicare," said AAFP President Lorie Heim, M.D., of Vass, N.C., in a prepared statement.
"The stability of federal payment is crucial to the success not just of Medicare but health reform as well," said Heim. "The health reform legislation calls on physicians to invest in changing their practices with health information technology, with new practice models that take time and money to implement, with new accountability standards and performance measurement reporting."
Physicians, she said, "can't invest in change if they can't count on payment for their services."
CMS released a statement on June 25, saying it has directed "Medicare claims administration contractors to discontinue processing claims at the negative update rates and to temporarily hold all claims for services rendered June 1, 2010, and later, until the new 2.2 percent update rates are tested and loaded into the Medicare contractors’ claims processing systems."
"Effective testing of the new 2.2 percent update will ensure that claims are correctly paid at the new rates," CMS said in the statement. "We expect to begin processing claims at the new rates no later than July 1, 2010. Claims for services rendered prior to June 1, 2010, will continue to be processed and paid as usual."
CMS also said, "Claims containing June 2010 dates of service which have been paid at the negative update rates will be reprocessed as soon as possible."
Under current law, Medicare payments to physicians and other providers paid under the Medicare Physician Fee Schedule, or MPFS, are based on the lesser of the submitted charge on the claim or the MPFS amount, according to the CMS statement.
Claims containing June dates of service that were submitted with charges greater than or equal to the new 2.2 percent update rate will be automatically reprocessed, CMS said.
Affected physicians who submitted claims containing June dates of service with charges less than the 2.2 percent update amount will need to contact their local Medicare contractor to request an adjustment, according to CMS. Submitted charges on claims cannot be altered without a request from the physician. Physicians should not re-submit claims already submitted to their Medicare contractor, CMS said.
The payment patch will apply retroactively to claims for services provided on or after June 1. The legislation also provides a 2.2 percent update in the Medicare payment rate until Nov. 30, effectively blocking cuts called for by the sustainable growth rate, or SGR, formula for the next five months.
"Although today's vote provides a reprieve from ruinous pay cuts that threaten the financial viability of primary care physicians' practices and -- therefore -- their patients' access to care, it is not a satisfactory way to provide long-term stability to Medicare," said AAFP President Lorie Heim, M.D., of Vass, N.C., in a prepared statement.
"The stability of federal payment is crucial to the success not just of Medicare but health reform as well," said Heim. "The health reform legislation calls on physicians to invest in changing their practices with health information technology, with new practice models that take time and money to implement, with new accountability standards and performance measurement reporting."
Physicians, she said, "can't invest in change if they can't count on payment for their services."
CMS released a statement on June 25, saying it has directed "Medicare claims administration contractors to discontinue processing claims at the negative update rates and to temporarily hold all claims for services rendered June 1, 2010, and later, until the new 2.2 percent update rates are tested and loaded into the Medicare contractors’ claims processing systems."
"Effective testing of the new 2.2 percent update will ensure that claims are correctly paid at the new rates," CMS said in the statement. "We expect to begin processing claims at the new rates no later than July 1, 2010. Claims for services rendered prior to June 1, 2010, will continue to be processed and paid as usual."
CMS also said, "Claims containing June 2010 dates of service which have been paid at the negative update rates will be reprocessed as soon as possible."
Under current law, Medicare payments to physicians and other providers paid under the Medicare Physician Fee Schedule, or MPFS, are based on the lesser of the submitted charge on the claim or the MPFS amount, according to the CMS statement.
Claims containing June dates of service that were submitted with charges greater than or equal to the new 2.2 percent update rate will be automatically reprocessed, CMS said.
Affected physicians who submitted claims containing June dates of service with charges less than the 2.2 percent update amount will need to contact their local Medicare contractor to request an adjustment, according to CMS. Submitted charges on claims cannot be altered without a request from the physician. Physicians should not re-submit claims already submitted to their Medicare contractor, CMS said.
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