Re: medicare charge

[Guest guest]

When it comes to Medicare non-covered services you can charge what you like but make darn sure the patient understands. That is where the ABN form comes in. Manipulation is a covered service but not for maintenance purposes. You can state that info on the ABN with detail as to the patient cost. They review, accept and sign, or turn the deal down. Then you have written aggreement. You still bill medicare but append the -GA modifier to the manipulation code.

J. Holzapfel, DCAlbany, Oregon

----- medicare chargeDate: Mon, 24 Oct 2011 13:11:02 -0700

Docs,

I am a participating provider in Medicare. If a Medicare patient is seeking out maintenance/supportive treatment, and therefore, paying out-of-pocket for the service, am I obligated to cap the charge according to the Medicare fee schedule? Or, may I charge my normal fee and only allow a payment at time of service discount? Thanks in advance for any responses.

Sorah, DC

Corvallis, OR

msorah@...

[Guest guest]

With MVAs as well as work comp one would bill the PIP or WC carrier first charging typical fees. Medicare acts as secondary and if for any reason there were charges not covered by the PIP or WC carrier billing Medicare would be futile as they would only reimburse for manipulation limited to their typical fee schedule. eg, You bill the PIP carrier $60 for manipulation, the PIP reimburses $50. If you bill Medicare the $10 balance they would deny based upon the fact that the $50 paid by the PIP carrier exceeds the pittance they would normally pay for the manipulation. I have experienced both examples in my practice and billed Medicare as secondary just for grins only to receive the expected denial. Problem is that opens up a new can of worms. Let's say you treated the patient for a lumbar sprain, 847.2, with subluxation code of 739.3 on the PIP claim. 12 months later, the PIP claim has been settled and paid for six months, the patient returns with a new lumbar sprain and subluxation. So, you bill Medicare. But lo and behold Medicare denies based upon the PIP claim. Then you have to jump through their hoops to demonstrate the PIP claim was resolved, settled and closed and the patient's new complaint, although similar, is a new injury and Medicare is responsible. Took me 12 months to get through to Medicare that a patient's low back injury was no longer related to her two year prior industrial injury.

J. Holzapfel, DCAlbany, Oregon

----- medicare chargeDate: Mon, 24 Oct 2011 13:11:02 -0700

Docs,

I am a participating provider in Medicare. If a Medicare patient is seeking out maintenance/supportive treatment, and therefore, paying out-of-pocket for the service, am I obligated to cap the charge according to the Medicare fee schedule? Or, may I charge my normal fee and only allow a payment at time of service discount? Thanks in advance for any responses.

Sorah, DC

Corvallis, OR

msorah@...