Re: RE: Medicare 2005

[Guest guest]

Hi ,

A participating physician can charge no more than the fee Medicare allows for

participating physicians. Medicare will deny any excess and inform the patient

they are not responsible for that additional amount. Any attempt to collect

that extra can be quite legally harmful to the physician. The non-participating

physician can charge and expect to collect up to the limit of the limiting

charge. So, there is a few bucks more there if one chooses. Medicare claims

the incentive to become participating is your claims are processed faster (but

not as fast as if you are billing electronically) and you are listed in their

guide of participating physicans, the list they encourage patients to use when

looking for a physician.

The Medicare carrier for Oregon, Noridian, currently does not have any set visit

limit. But you must use the proper treatment modifier to inform them of the

purpose for that patient's visit. There are other carriers in the U.S. that

have set visit limits but those are being challenged. I am trying to keep an

eye on Noridian in case they try to institute limits. Just be ready to respond

with your records if the carrier decides to deny.

Holzapfel DC

Albany, OR.

[Guest guest]

Dr. Bob,

Yep, if you have been non-part. then do nothing. Filling out the form is a request to be considered participating. As a non-participating physician charge you can charge up to, but not to exceed, the limiting charge.

Holzapfel DC

Albany, OR.

On Tue, 21 Dec 2004 17:51:29 -0800 " s, D.C." <drbobdc@...> writes:

Hey ,

So, if I'm non-participating (which I've always been), and am staying non-participating, I don't need to fill out that form, right?

Also, as a non-participating physician, can we charge the "Limiting Charge" or ONLY the "Non-Participating" fee?

Thanks for all of your Medicare information, it's really helpful. Also, thanks for the Corvallis referrals. I'll pass both names along to the patient.

Bob.

RE: Medicare 2005

Listees,

Changes for Medicare in yr 2005...your patient's deductible will be increased by $10. There also is a slight change in fees as follows:

Locality 99 (all other counties)

CODE NON-PAR PARTICIPATING LIMITING CHARGE

98940 $24.05 $25.32 $27.66

98941 33.75 35.53 38.81

98942 43.68 45.98 50.23

Locality 01 (Washington, Clackamas, Multnomah counties)

98940 $25.08 $26.40 $28.84

98941 35.09 36.94 40.35

98942 45.29 47.67 52.08

If you are a non-participating physician and wish to become so you must complete and submit form CMS-460 (attached). If you are participating and wish to change to non-participating you must inform Medicare by writing a letter, on your letterhead, stating such. The deadline for each is December 31, 2004. Address any request to Medicare Part B, Attention Provider Enrollment, PO Box 6702, Fargo, ND 58108-6702.

Hope this is helpful. Happy Holidays...

J. Holzapfel, D.C.Albany, OR. kjholzdc@...http://docman.chiroweb.comOre'>http://docman.chiroweb.comOregonDCs rules:1. Keep correspondence professional; the purpose of the listserve is to foster communication and collegiality. No personal attacks on listserve members will be tolerated.2. Always sign your e-mails with your first and last name.3. The listserve is not secure; your e-mail could end up anywhere. However, it is against the rules of the listserve to copy, print, forward, or otherwise distribute correspondence written by another member without his or her consent, unless all personal identifiers have been removed.

J. Holzapfel, D.C.Albany, Oregon541-928-4060kjholzdc@...http://docman.chiroweb.com

[Guest guest]

,

If a patient hurts themselves as you suggest then any services provided for alleviation of their signs and symptoms should be reimbursable under Medicare. Just remember to attach the AT modifier signifying "acute treatment", make sure your HCFA reflects the date of initiation of treatment for that condition (injury date box 14), and chart your history, examination, diagnosis and treatment accordingly. This is one area where the outcomes assesment forms recommended by Vern Saboe DC can be helpful in establishing the effects of a new injury, exacerbation of an old injury, and measuring its significance. The key is document, document, document. Around the country that is one of the biggest problems regarding reimbursement for chiropractic care under Medicare. Many of the problems resulting in Medicare denial of payment has centered around inadequate record keeping by DCs. On a national level there is an effort by the ACA and state reps to encourage DCs and train if necessary to document thoroughly and properly.

Holzapfel DC

Albany, OR.

On Wed, 22 Dec 2004 13:52:54 EST ANG320@... writes:

What are the rules about ADL and adjustments with Medicare. If a patient hurts themselves during ADL - such as lifting a box, getting clothes out of the dryer, bending over to garden etc - will Medicare pay for treatment or does it require a real and significant accident like a fall down stairs etc? Anglen