Medicare ABN

[Guest guest]

In reviewing the new ABN for 2012 in option 2 the pt wants the service but it requests that the pt does not want medicare billed. I was under the impression that we HAD to bill medicare regardless. ... and other medicare experrts your thoughts on this. There also some gramatical errors can we correct or does it have to stay as is?Dr. A Caughlin DC CAC155 NW 1st Ave Day, Or. 97845 office 541-575-1063 fax 541-575-5554

[Guest guest]

My understanding is that you add modifyer -GY to CPT's for ultrasound,

interferential, massage...etc and do not bill. The only thing billed is the

CMT.

Brad Rethwill DC

Eugene

>

>

> In reviewing the new ABN for 2012 in option 2 the pt wants the service but it

requests that the pt does not want medicare billed. I was under the impression

that we HAD to bill medicare regardless. ... and other medicare

experrts your thoughts on this. There also some gramatical errors can we

correct or does it have to stay as is?

>

> Dr. A Caughlin DC CAC155 NW 1st Ave

> Day, Or. 97845

> office 541-575-1063

> fax 541-575-5554

>

[Guest guest]

,

we got a verbal denial for payment based on the fact that medicare no longer takes any billings that aren't electronic. I thought an office with less than 10 employees was exempt for now??? Is that correct? And if so, do you have anything we can send them. The person who said this, was very adamant and told the patient this 'fact' that our office didn't bill correctly.

Minga Guerrero DC

abowoman@...

RE: Re: Medicare ABN

Technically, extraspinal treatment is a non-covered service for which billing Medicare is not required. But, in the very rare case the patient's supplemental coverage may cover the care and assuming Medicare is primary, billing Medicare first simply to obtain their denial shifting the burden to the supplement or secondary may be in order (oh that is a long sentence...run on?). I bill Medicare everything I do, therapy, EM, etc., attaching the -GY modifier where appropriate, just so the patient knows what is performed, billed, denied, etc. Again, it is rare, but there are supplements that may pay on those services denied by Medicare as non-covered. Plus then my chartnote records and billing records agree on all services performed. Never had anyone question that but just cya on my part (or would that be cma?).

Long ago Dr revealed a little known clause that prohibits a doc from billing Medicare if a recipient, by their own free will, prohibits the doc from doing so. Written instruction from the recipient in the file would be very advisable. Option 2 on the new ABN gives the recipient that opportunity to instruct the doc NOT to bill Medicare and provides the in file written proof the doc needs. Also, note in option 2 the recipient agrees never to appeal. Before this the recipient, or ANY person representing the recipient at any time in the future, could appeal a decision not to bill Medicare. This left us docs in a precarious position. We can't "opt out", but with the recipient's direction we can now not bill Medicare at the recipient's direction. DOCUMENT, DOCUMENT, DOCUMENT...

J. Holzapfel, DC

Albany, Oregon

----- Re: Medicare ABN

My understanding is that you add modifyer -GY to CPT's for ultrasound, interferential, massage...etc and do not bill. The only thing billed is the CMT.

Brad Rethwill DC

Eugene

>

>

> In reviewing the new ABN for 2012 in option 2 the pt wants the service but it requests that the pt does not want medicare billed. I was under the impression that we HAD to bill medicare regardless. ... and other medicare experrts your thoughts on this. There also some gramatical errors can we correct or does it have to stay as is?

>

> Dr. A Caughlin DC CAC155 NW 1st Ave

> Day, Or. 97845

> office 541-575-1063

> fax 541-575-5554

>