Re: Re: Medicare or Nordian question

[Guest guest]

Janell,

Chiropractors can not "non-participate." We do not have the opt out option that Medical doctors have. We are all participating, whether you want to or not. If you see one Medicare patient, you are participating. Period, the law.

You can refuse to treat anyone on Medicare, that's your only "option." If you treat those on the plan you can be "assigned" or "non-assigned," which basically determines whether the government pays you or the patient.

If Medicare is the primary, you have to tell Medicare when you adjust a patient. Also the law. If you do not tell Medicare you have adjusted the patient and have not had a signed ABN, you have committed fraud. Billing the secondary is not the right direction, since you must bill the Medicare plan first.

Those are some of the comments I have on your email. I've been dealing with Medicare for nearly 20 years and most of the time they no longer make me go through the roof. I've taken numerous Medicare trainings and there is no way I'll ever figure them out. Frustrating and rule-bound, yes, but the rules do change weekly, so don't worry too much! You have to watch what Noridian does each and every week.

Good Luck!

Christian Mathisen, D.C., CCWFN

cmathdc@...

Re: Medicare or Nordian question

Thank you for the information! I think if anyone thinks you're a conspiracy theorist their head is in the sand and they should do a little more asking questions and research about this and other "weird" topics. hahaI don't have much input on this because Medicare billing is confusing to me and I think all my Medicare patients (not many) have supplemental insurance so it goes through that ins. I am non-par with Medicare. I hope to hear some interesting comments on this.

Janell Chandler, DC

Doctor of Chiropractic

7809 NE 94th Avenue

Vancouver, WA 98662

Office:

Cellular:

[Guest guest]

Dr. Chandler,

Dr. Mathisen is correct. Please don't bill secondary without billing medicare. You could get in a lot of trouble. You could send your billing person to medicare seminars to update on the laws if you'd rather spend time 'dealing with healing'. They can report back to you at your reg staff meetings. I attend one seminar (medicare) every other yr or so, and have staff attend many more. They read all the links that are sent to our office and then report on the updates at staff meetings.

Here's a problem you may encounter with your current billing procedures. Say a medicare patient is in an auto accident. You bill auto. However, for some reason, part of the auto bill is denied. The case closes with the patient owing some $$$. The patient asks you to bill medicare, which is their right. If you didn't have them sign the ABN form at the beginning of the auto case,and explain that nothing but the adjustment is covered with medicare, you can't ask for them to pay the difference. And most likely, if the bill is sent to medicare a year after services, (when you finally find out the auto claim is denied); you will be audited, denied payment from medicare and have trouble.

Dr. Matthisen's comment that if you treat even one medicare age patient, you have to accept all, is correct. So if you truly want to be independent of all medicare billing, you must turn away medicare age patients who've been in auto accidents, personal injuries, ALL cases.

My office is non-par. We have the patient pay upfront and bill medicare. Every patient signs an ABN form and has a formal verbal description of the ABN contract language. I repeat this verbal language if I haven't seen them in greater than 6 months and have them sign the ABN form regularly.

While on the board, I did see complaints from elderly patients about this very thing. I also saw a complaint from a family member who thought the ABN rules weren't explained to their elder relatives adequately. Generally these types of complaints resolve with no violation to the doctor, since most board members realize the complexities of dealing with medicare. Still, a complaint causes a great deal of stress and months of However, I can't speak for all seated boards. Once a doctor has the knowledge, or has heard of the rules, it's harder to ignore a complaint.

Minga Guerrero DC

abowoman@...

Re: Re: Medicare or Nordian question

Janell,

Chiropractors can not "non-participate." We do not have the opt out option that Medical doctors have. We are all participating, whether you want to or not. If you see one Medicare patient, you are participating. Period, the law.

You can refuse to treat anyone on Medicare, that's your only "option." If you treat those on the plan you can be "assigned" or "non-assigned," which basically determines whether the government pays you or the patient.

If Medicare is the primary, you have to tell Medicare when you adjust a patient. Also the law. If you do not tell Medicare you have adjusted the patient and have not had a signed ABN, you have committed fraud. Billing the secondary is not the right direction, since you must bill the Medicare plan first.

Those are some of the comments I have on your email. I've been dealing with Medicare for nearly 20 years and most of the time they no longer make me go through the roof. I've taken numerous Medicare trainings and there is no way I'll ever figure them out. Frustrating and rule-bound, yes, but the rules do change weekly, so don't worry too much! You have to watch what Noridian does each and every week.

Good Luck!

Christian Mathisen, D.C., CCWFN

cmathdc@...

Re: Medicare or Nordian question

Thank you for the information! I think if anyone thinks you're a conspiracy theorist their head is in the sand and they should do a little more asking questions and research about this and other "weird" topics. haha

I don't have much input on this because Medicare billing is confusing to me and I think all my Medicare patients (not many) have supplemental insurance so it goes through that ins. I am non-par with Medicare. I hope to hear some interesting comments on this.

Janell Chandler, DC

Doctor of Chiropractic

7809 NE 94th Avenue

Vancouver, WA 98662

Office:

Cellular:

[Guest guest]

Thoughts on MedicareI have been a participating medicare provider since I began practice in 1980.  Medicare supported chiropractic from the start.  It is not a perfect system but if you do your homework and stay on top of it it works and it is important to your patients and the future of chiropractic. All eyes are looking at Medicare!  How Medicare goes is how the future goes- if you think Medicare is a problem good luck with the advantage programs that are cutting out chiropractic.  Take the chiropractic classes that are offered by Noridian, they do a terrific job- this applies to your CE credit.  Are you really going to choose to not treat our baby boomers? 

Newport Avenue Chiropractic

Glenn J. Asti D.C.

1052 NW Newport Avenue 

Suite 101

Bend,  OR  97701

www.newportavenuechiropractic.com

email: 

dr.asti@...

 

Chiropractic

is health insurance. Premiums small. Dividends large.

                                                                               B.J. Palmer

 

Dr. Chandler,

Dr. Mathisen is correct. Please don't bill secondary without billing medicare. You could get in a lot of trouble. You could send your billing person to medicare seminars to update on the laws if you'd rather spend time 'dealing with healing'. They can report back to you at your reg staff meetings. I attend one seminar (medicare) every other yr or so, and have staff attend many more. They read all the links that are sent to our office and then report on the updates at staff meetings.

Here's a problem you may encounter with your current billing procedures. Say a medicare patient is in an auto accident. You bill auto. However, for some reason, part of the auto bill is denied. The case closes with the patient owing some $$$. The patient asks you to bill medicare, which is their right. If you didn't have them sign the ABN form at the beginning of the auto case,and explain that nothing but the adjustment is covered with medicare,  you can't ask for them to pay the difference. And most likely, if the bill is sent to medicare a year after services, (when you finally find out the auto claim is denied); you will be audited, denied payment from medicare and have trouble.

 

Dr. Matthisen's comment that if you treat even one medicare age patient, you have to accept all, is correct. So if you truly want to be independent of all medicare billing, you must turn away medicare age patients who've been in auto accidents, personal injuries, ALL cases.

 

My office is non-par. We have the patient pay upfront and bill medicare. Every patient signs an ABN form and has a formal verbal description of the ABN contract language. I repeat this verbal language if I haven't seen them in greater than 6 months and have them sign the ABN form regularly.

 

While on the board, I did see complaints from elderly patients about this very thing. I also saw a complaint from a family member who thought the ABN rules weren't explained to their elder relatives adequately. Generally these types of complaints resolve with no violation to the doctor, since most board members realize the complexities of dealing with medicare. Still, a complaint causes a great deal of stress and months of  However, I can't speak for all seated boards. Once a doctor has the knowledge, or has heard of the rules, it's harder to ignore a complaint.

 

 

Minga Guerrero DC

abowoman@...

Re: Re: Medicare or Nordian question

 

Janell,

Chiropractors can not " non-participate. " We do not have the opt out option that Medical doctors have. We are all participating, whether you want to or not. If you see one Medicare patient, you are participating. Period, the law.

 

You can refuse to treat anyone on Medicare, that's your only " option. " If you treat those on the plan you can be " assigned " or " non-assigned, " which basically determines whether the government pays you or the patient.

 

If Medicare is the primary, you have to tell Medicare when you adjust a patient. Also the law. If you do not tell Medicare you have adjusted the patient and have not had a signed ABN, you have committed fraud. Billing the secondary is not the right direction, since you must bill the Medicare plan first.

 

Those are some of the comments I have on your email. I've been dealing with Medicare for nearly 20 years and most of the time they no longer make me go through the roof. I've taken numerous Medicare trainings and there is no way I'll ever figure them out. Frustrating and rule-bound, yes, but the rules do change weekly, so don't worry too much! You have to watch what Noridian does each and every week.

 

Good Luck!

 

Christian Mathisen, D.C., CCWFN

cmathdc@...

 

 

Re: Medicare or Nordian question

 

Thank you for the information!  I think if anyone thinks you're a conspiracy theorist their head is in the sand and they should do a little more asking questions and research about this and other " weird " topics. haha

I don't have much input on this because Medicare billing is confusing to me and I think all my Medicare patients (not many) have supplemental insurance so it goes through that ins.  I am non-par with Medicare.  I hope to hear some interesting comments on this.

 

Janell Chandler, DC

Doctor of Chiropractic

7809 NE 94th Avenue

Vancouver, WA 98662

Office:

Cellular:

[Guest guest]

Minga,

Where do I get these ABN forms... I too am non-par an non assignment which I assume I need this form for all Medicare to sign, correct.

Walt

Eagle Point

Subject: Re: Re: Medicare or Nordian questionTo: cmathdc@..., oregondcs , jchandler@...Date: Friday, April 6, 2012, 10:09 AM

Dr. Chandler,

Dr. Mathisen is correct. Please don't bill secondary without billing medicare. You could get in a lot of trouble. You could send your billing person to medicare seminars to update on the laws if you'd rather spend time 'dealing with healing'. They can report back to you at your reg staff meetings. I attend one seminar (medicare) every other yr or so, and have staff attend many more. They read all the links that are sent to our office and then report on the updates at staff meetings. Here's a problem you may encounter with your current billing procedures. Say a medicare patient is in an auto accident. You bill auto. However, for some reason, part of the auto bill is denied. The case closes with the patient owing some $$$. The patient asks you to bill medicare, which is their right. If you didn't have them sign the ABN form at the beginning of the auto case,and explain that nothing but the adjustment is covered with medicare, you can't

ask for them to pay the difference. And most likely, if the bill is sent to medicare a year after services, (when you finally find out the auto claim is denied); you will be audited, denied payment from medicare and have trouble.

Dr. Matthisen's comment that if you treat even one medicare age patient, you have to accept all, is correct. So if you truly want to be independent of all medicare billing, you must turn away medicare age patients who've been in auto accidents, personal injuries, ALL cases.

My office is non-par. We have the patient pay upfront and bill medicare. Every patient signs an ABN form and has a formal verbal description of the ABN contract language. I repeat this verbal language if I haven't seen them in greater than 6 months and have them sign the ABN form regularly.

While on the board, I did see complaints from elderly patients about this very thing. I also saw a complaint from a family member who thought the ABN rules weren't explained to their elder relatives adequately. Generally these types of complaints resolve with no violation to the doctor, since most board members realize the complexities of dealing with medicare. Still, a complaint causes a great deal of stress and months of However, I can't speak for all seated boards. Once a doctor has the knowledge, or has heard of the rules, it's harder to ignore a complaint.

Minga Guerrero DCabowoman@...

Re: Re: Medicare or Nordian question

Janell,

Chiropractors can not "non-participate." We do not have the opt out option that Medical doctors have. We are all participating, whether you want to or not. If you see one Medicare patient, you are participating. Period, the law.

You can refuse to treat anyone on Medicare, that's your only "option." If you treat those on the plan you can be "assigned" or "non-assigned," which basically determines whether the government pays you or the patient.

If Medicare is the primary, you have to tell Medicare when you adjust a patient. Also the law. If you do not tell Medicare you have adjusted the patient and have not had a signed ABN, you have committed fraud. Billing the secondary is not the right direction, since you must bill the Medicare plan first.

Those are some of the comments I have on your email. I've been dealing with Medicare for nearly 20 years and most of the time they no longer make me go through the roof. I've taken numerous Medicare trainings and there is no way I'll ever figure them out. Frustrating and rule-bound, yes, but the rules do change weekly, so don't worry too much! You have to watch what Noridian does each and every week.

Good Luck!

Christian Mathisen, D.C., CCWFN

cmathdc@...

Re: Medicare or Nordian question

Thank you for the information! I think if anyone thinks you're a conspiracy theorist their head is in the sand and they should do a little more asking questions and research about this and other "weird" topics. hahaI don't have much input on this because Medicare billing is confusing to me and I think all my Medicare patients (not many) have supplemental insurance so it goes through that ins. I am non-par with Medicare. I hope to hear some interesting comments on this.

Janell Chandler, DC

Doctor of Chiropractic

7809 NE 94th Avenue

Vancouver, WA 98662

Office:

Cellular:

[Guest guest]

Thanks for the advice Minga and Christian! It's not the secondary insurance I was talking about, but that their Medicare plan is managed by another company (i.e. UHC or ASHN), which is called " supplemental " , right? So I believe it goes to Medicare through

that ins company. ? Is this right?

Janell Chandler, DC

Doctor of Chiropractic

7809 NE 94th Avenue

Vancouver, WA 98662

Office:

Cellular:

From: abowoman@... [abowoman@...]

Sent: Friday, April 06, 2012 10:09 AM

To: cmathdc@...; oregondcs ; Janell Chandler

Subject: Re: Re: Medicare or Nordian question

Dr. Chandler,

Dr. Mathisen is correct. Please don't bill secondary without billing medicare. You could get in a lot of trouble. You could send your billing person to medicare seminars to update on the laws if you'd rather spend time 'dealing with healing'. They can

report back to you at your reg staff meetings. I attend one seminar (medicare) every other yr or so, and have staff attend many more. They read all the links that are sent to our office and then report on the updates at staff meetings.

Here's a problem you may encounter with your current billing procedures. Say a medicare patient is in an auto accident. You bill auto. However, for some reason, part of the auto bill is denied. The case closes with the patient owing some $$$. The patient asks

you to bill medicare, which is their right. If you didn't have them sign the ABN form at the beginning of the auto case,and explain that nothing but the adjustment is covered with medicare, you can't ask for them to pay the difference. And most likely, if

the bill is sent to medicare a year after services, (when you finally find out the auto claim is denied); you will be audited, denied payment from medicare and have trouble.

Dr. Matthisen's comment that if you treat even one medicare age patient, you have to accept all, is correct. So if you truly want to be independent of all medicare billing, you must turn away medicare age patients who've been in auto accidents, personal

injuries, ALL cases.

My office is non-par. We have the patient pay upfront and bill medicare. Every patient signs an ABN form and has a formal verbal description of the ABN contract language. I repeat this verbal language if I haven't seen them in greater than 6 months and

have them sign the ABN form regularly.

While on the board, I did see complaints from elderly patients about this very thing. I also saw a complaint from a family member who thought the ABN rules weren't explained to their elder relatives adequately. Generally these types of complaints resolve

with no violation to the doctor, since most board members realize the complexities of dealing with medicare. Still, a complaint causes a great deal of stress and months of However, I can't speak for all seated boards. Once a doctor has the knowledge, or has

heard of the rules, it's harder to ignore a complaint.

Minga Guerrero DC

abowoman@...

Re: Re: Medicare or Nordian question

Janell,

Chiropractors can not " non-participate. " We do not have the opt out option that Medical doctors have. We are all participating, whether you want to or not. If you see one Medicare patient, you are participating. Period, the law.

You can refuse to treat anyone on Medicare, that's your only " option. " If you treat those on the plan you can be " assigned " or " non-assigned, " which basically determines whether the government pays you or the patient.

If Medicare is the primary, you have to tell Medicare when you adjust a patient. Also the law. If you do not tell Medicare you have adjusted the patient and have not had a signed ABN, you have committed fraud. Billing the secondary is

not the right direction, since you must bill the Medicare plan first.

Those are some of the comments I have on your email. I've been dealing with Medicare for nearly 20 years and most of the time they no longer make me go through the roof. I've taken numerous Medicare trainings and there is no way I'll

ever figure them out. Frustrating and rule-bound, yes, but the rules do change weekly, so don't worry too much! You have to watch what Noridian does each and every week.

Good Luck!

Christian Mathisen, D.C., CCWFN

cmathdc@...

Re: Medicare or Nordian question

Thank you for the information! I think if anyone thinks you're a conspiracy theorist their head is in the sand and they should do a little more asking questions and research about this and other " weird " topics. haha

I don't have much input on this because Medicare billing is confusing to me and I think all my Medicare patients (not many) have supplemental insurance so it goes through that ins. I am non-par with Medicare. I hope to hear some interesting comments on this.

Janell Chandler, DC

Doctor of Chiropractic

7809 NE 94th Avenue

Vancouver, WA 98662

Office:

Cellular:

[Guest guest]

If it's called supplemental, it's secondary. to be certain, call the supplemental ins and ask if they are 'primary'. I doubt they are if they have the designation of supplemental. There are some plans with Kaiser that are primary, so you bill CHP as the primary. MY staff makes it a regular habit to call every supplemental insurance, get the name of the person you speak with, time and date; ask these billing questions. We have an insurance worksheet that we hand the patient after we've researched the questions regarding billing. The patient signs it. It's reviewed on the first or second appt and we keep a copy and offer one to the patient. Did you get this training at UWS? Or are you a UWS graduate?

Minga Guerrero DC

abowoman@...

Re: Re: Medicare or Nordian question

Janell,

Chiropractors can not "non-participate." We do not have the opt out option that Medical doctors have. We are all participating, whether you want to or not. If you see one Medicare patient, you are participating. Period, the law.

You can refuse to treat anyone on Medicare, that's your only "option." If you treat those on the plan you can be "assigned" or "non-assigned," which basically determines whether the government pays you or the patient.

If Medicare is the primary, you have to tell Medicare when you adjust a patient. Also the law. If you do not tell Medicare you have adjusted the patient and have not had a signed ABN, you have committed fraud. Billing the secondary is not the right direction, since you must bill the Medicare plan first.

Those are some of the comments I have on your email. I've been dealing with Medicare for nearly 20 years and most of the time they no longer make me go through the roof. I've taken numerous Medicare trainings and there is no way I'll ever figure them out. Frustrating and rule-bound, yes, but the rules do change weekly, so don't worry too much! You have to watch what Noridian does each and every week.

Good Luck!

Christian Mathisen, D.C., CCWFN

cmathdc@...

Re: Medicare or Nordian question

Thank you for the information! I think if anyone thinks you're a conspiracy theorist their head is in the sand and they should do a little more asking questions and research about this and other "weird" topics. haha

I don't have much input on this because Medicare billing is confusing to me and I think all my Medicare patients (not many) have supplemental insurance so it goes through that ins. I am non-par with Medicare. I hope to hear some interesting comments on this.

Janell Chandler, DC

Doctor of Chiropractic

7809 NE 94th Avenue

Vancouver, WA 98662

Office:

Cellular: