Re: medicare help

[Guest guest]

Hi ya Alan,

Yeah, I got one of those on 04/03 also. I telephoned EDI Services for

Noridian and spoke with " " , 800-967-7902, after a very short time

on hold. I do not have any employees but as a one-doc office qualify

under the category of " Intermediary small providers " , as I am sure many

docs do. Due to the fact that I do not have any payroll records to

submit she requested a copy of my Federal Tax Return, Schedule C, which

has a line where one would list any wages paid to employees of the

business. In my case this line would be blank, further demonstrating I

do not have any employees to submit payroll records for. My request from

Medicare asked for payroll records from Oct 1, 2005 through Dec 31, 2005.

I assume yours also requested a specific period. If EDI is saying no

documentation was submitted with the waiver request then I would assume

someone lost the paperwork or what you submitted was not exactly what

they wanted. Follow-up with a telephone call. Call the number above

and try to work this out. Keep me looped also so I can track your

progress. Good luck...

J. Holzapfel, DC

Albany

On Tue, 11 Apr 2006 22:07:47 -0000 " albee22001 " <Creswellchiro@...>

writes:

> Help, they're after us!

>

> We got a notice of " Review of Paper Claims Submission Practices "

> from

> Medicare. We sent it back noting that we are a one-doctor, one-staff

>

> office, and sent documentation in the form of our most recent

> payroll

> record.

>

> We got a notice back saying, among other things, that our request to

>

> continue paper submissions had been denied " because no documentation

>

> was submitted with the waiver request. " Not true, but my fear is

> that

> once they have it checked in some box on a computer, we are going to

>

> be locked into bureaucratic hell without a way out.

>

> And, of course, there is no number to call if you have questions,

> and

> the phone number I got from the Medicare Website was an automated

> help line.

>

> Is there any way you can help, or at least get me a number I can

> call

> to (God willing) straighten this mess out?

>

> All we want is to let us bill for our (way) reduced reimbursement

> via

> paper -- helllllp!!!!

>

> And, thank you.

>

> Alan

> Creswell Chiropractic

>

>

>

>

>

>

J. Holzapfel, D.C.

Albany, OR.

kjholzdc@...

[Guest guest]

I have been out of practice for awhile.

1) If a doctor is not signed up as a Medicare provider - and they treat a Medicare patient but do not want to accept assignment- do they need to bill medicare and wait to see what Medicare's decision is before collecting money from a Medicare patient? Do you have to wait to see if the visit is determined to be medically necessary or can you collect cash payment at the time of service?

2) Do you need to bill Medicare if you do not adjust - if for example you just do a therapy or just do acupuncture?

3) If you adjust AND do a therapy on a Medicare patient - and the adjustment was determined to be NOT medically necessary - can you still collect on the therapy?

Anglen

[Guest guest]

Hi ,

1) Was the doctor signed up as a Medicare provider in the past? If so, you basically carry the Medicare provider ID number for life... A doc needs to have a Medicare provider number before billing Medicare. That is how Medicare identifies the doc. Whether the doc is participating or nonparticipating the doc is required to bill Medicare. If the treatment rendered is not medically necessary by Medicare standards (i.e. maintenance care, wellness care) and the doc has a patient-signed ABN form which informs the patient Medicare will not likely pay, the doc may collect from the patient but must still bill Medicare using appropriate CPT codes and modifiers. A doc can collect from the patient at the time of service, the full amount if non-par, the expected Medicare unpaid portion if par.

2) I would recommend billing Medicare despite advance knowledge that Medicare will not pay, again using the appropriate modifiers. Otherwise Medicare may inform the patient he/she is not obligated to pay. Also, some secondaries may pay on non-covered Medicare services such as therapy or acupuncture.

3) Good question, I have not considered this before. I would suppose the answer is yes if again the doc bills the manipulation and therapy with appropriate modifiers. i.e. Any therapy is non-covered, therefore the HCFA should still show the therapy CPT code followed by modifier -GY which informs Medicare the patient is aware the therapy is a non-covered service and is aware they are responsible for payment. If the doc feels the manipulation should not have been denied (-AT modifier was attached to the manipulation CPT code, chartnotes support curative/corrective care..."-AT" could be thought of as "acute treatment") there is an appeal process.

Call me, 541-928-4060, if you have any questions...

J. Holzapfel, D.C.Albany, Oregon541-928-4060kjholzdc@...

[Guest guest]

In a message dated 6/13/2006 9:16:52 PM US Mountain Standard Time, kjholzdc@... writes:

1) Was the doctor signed up as a Medicare provider in the past? If so, you basically carry the Medicare provider ID number for life... A doc needs to have a Medicare provider number before billing Medicare. That is how Medicare identifies the doc. Whether the doc is participating or nonparticipating the doc is required to bill Medicare.

I guess I should have said the doctor (ME ) is non-par. So as a non-par doctor, do I need to await Medicare's decision prior to collecting the money? And if it is determined to be non-medically necessary, and I have no ABN signed - do I need to refund the money?

2) I would recommend billing Medicare despite advance knowledge that Medicare will not pay, again using the appropriate modifiers. Otherwise Medicare may inform the patient he/she is not obligated to pay.

I was under the impression that chiropractors did not need to bill for non-covered services such as acupuncture. If you do not bill for acupuncture, for example, how will Medicare inform the patient they are not obligated to pay?

Thank you for including your phone number, I will be giving you a call. It has been over a year since I have practiced and need to get a few pointers of dealing with Medicare patients.

Anglen

[Guest guest]

I guess I should have said the doctor (ME ) is non-par. So as a non-par doctor, do I need to await Medicare's decision prior to collecting the money? And if it is determined to be non-medically necessary, and I have no ABN signed - do I need to refund the money?

The non-par doc may collect from the patient at time of service. If the service is determined to be non-med necessary and no ABN has been signed the patient will be advised they are not responsible and any money that has been paid must be refunded. In such case I cannot stress enough the importance of the ABN and the use of appropriate billing modifiers (-AT, -GY, -GA) as well as supportive chartnotes.

I was under the impression that chiropractors did not need to bill for non-covered services such as acupuncture. If you do not bill for acupuncture, for example, how will Medicare inform the patient they are not obligated to pay?

True, but it is recommended chiros bill for non-covered services in case secondary coverage exists for those non-covered services (in my experience this is rare but I have seen a few patients where their secondary did reimburse for the therapy). In times past Medicare has taken the position that if the service was not billed, it was not provided. I don't believe this is policy but let me do some checking on that.

J. Holzapfel, D.C.Albany, OR. kjholzdc@...

On Wed, 14 Jun 2006 12:11:13 EDT ANG320@... writes:

In a message dated 6/13/2006 9:16:52 PM US Mountain Standard Time, kjholzdc@... writes:

1) Was the doctor signed up as a Medicare provider in the past? If so, you basically carry the Medicare provider ID number for life... A doc needs to have a Medicare provider number before billing Medicare. That is how Medicare identifies the doc. Whether the doc is participating or nonparticipating the doc is required to bill Medicare. I guess I should have said the doctor (ME ) is non-par. So as a non-par doctor, do I need to await Medicare's decision prior to collecting the money? And if it is determined to be non-medically necessary, and I have no ABN signed - do I need to refund the money?

2) I would recommend billing Medicare despite advance knowledge that Medicare will not pay, again using the appropriate modifiers. Otherwise Medicare may inform the patient he/she is not obligated to pay. I was under the impression that chiropractors did not need to bill for non-covered services such as acupuncture. If you do not bill for acupuncture, for example, how will Medicare inform the patient they are not obligated to pay?Thank you for including your phone number, I will be giving you a call. It has been over a year since I have practiced and need to get a few pointers of dealing with Medicare patients. Anglen