Medicare

[Guest guest]

We've had the same problem in the past.. RE-BILL everything from the

last billing date that was rejected. If you are accused of double

billing your defense is that you CAN NOT write on the HCFA 1500 that it

is a RE-BILL. Their computers are supposed to delete the double bill

and indicate such on the EOB.

W. Pfeiffer,D.C.;D,A.B.C.O.

P. O. Box 606

Pendleton, Or. 97801

Re: Medicare

will they may have nothing else to do but they just rejected over $1500

in

billings at my office for lack of the word none as well.

Take care

steve kinne

Medicare

> >

> > Hi all!

> >

> > Medicare has a new requirement that will generate reject notices

this

> month

> > (I have them already). Now we have to complete box 11 with the word

> " none "

> > to indicate no other insurance is primary except Medicare.

> >

> > Happy form corrections to you.

> >

> > Willard

> >

>

>

>

> OregonDCs 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.

>

>

[Guest guest]

I'm ducking as I say this.....if Measure 23 passes we won't have to be at the mercy of the whims, prejudices, and bad decisions of a myriad of agencies.

Just one.

Start throwing.

Terry Petty

Medicare

Docs,

My office was communicating to my billing agency (my hired billing service)yesterday about Medicare and to say the least, my staff is beginning to shy away from the complexities of the Medicare billing requirements. The spending $30.00 to make $20.00 thing is becomming way too oppressive. During that conversation our agency person says in a 'purely constructively business observational manner,' " Dr. Lumsden needs to get a P.T. degree--they bill for all kinds of things and get paid from Medicare real well. " Oh yea, when I heard this, you's guy's can imagine....

So, have any of you actually refused assignment once you've been accepting assignment for years? What kind of sanctions and/or embargos are placed upon your life by the Medicare people? I have always worked well with the elderly and enjoy such but this has gone over the top, especially with the new October rules on track.

With the warmest level-playing field regards,

[Guest guest]

Terry:

If measure 23 passes we will lose private insurance, PIP (thats kind'a big one), and what Workers comp we have.

British Columbia has this system and is continually broke. Initially this system was wonderful for the DC's but since there was no governor, no co-payment, nothing to make the Canadian consumers at least blink a little before running to their doctor for just about every little thing they started to break and finally broke the system.

Guess who were the first to take a hit in hopes of saving money and the downward slide of this socialized medical system, you guessed it the DC's, first with reduced fees per visit, then on to reduced numbers of visits, then on to a $15 co-payment when the MD's had none of the above placed on them.

History has a way of repeating itself Terry.

Just my little ol' two cents worth.

Vern

Medicare

Docs,

My office was communicating to my billing agency (my hired billing service)yesterday about Medicare and to say the least, my staff is beginning to shy away from the complexities of the Medicare billing requirements. The spending $30.00 to make $20.00 thing is becomming way too oppressive. During that conversation our agency person says in a 'purely constructively business observational manner,' "Dr. Lumsden needs to get a P.T. degree--they bill for all kinds of things and get paid from Medicare real well." Oh yea, when I heard this, you's guy's can imagine....

So, have any of you actually refused assignment once you've been accepting assignment for years? What kind of sanctions and/or embargos are placed upon your life by the Medicare people? I have always worked well with the elderly and enjoy such but this has gone over the top, especially with the new October rules on track.

With the warmest level-playing field regards,OregonDCs 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.

[Guest guest]

Hi all, we are new to the list-serve and were wondering if anyone could aid us with some Medicare Qs. First off we have heard so many bad things about reimbursement but the people who tell us that still accept it? Any advice would be appreciated, we are in a community with many seniors and have many patients who are losing their regular insurance due to age and going to Medicare.

Thank you much,

Josh and Kuhn

OregonDCs 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.

[Guest guest]

Medicare

<<...OLE_Obj...>>

TO: Chiropractic State Associations Members of the National Association of Chiropractic Attorneys FROM: , D.C. ACA Chairman DATE: July 24, 2003 RE: Analysis - Manzullo Medicare Bill H.R.2560 This memo is being generated in response to inquiries the ACA has received from state chiropractic associations and others regarding H.R. 2560, Medicare-related legislation recently introduced in the U.S. House of Representatives by Representative Don Manzullo(R-Illinois).

As you may know, Representative Manzullo is a strong chiropractic supporter and a respected Member of Congress. Although we view his introduction of H.R. 2560 as a well-intended attempt (on his part) to benefit the chiropractic profession, we have identified several serious problems regarding the content of H.R. 2560 - and in our judgment the legislation -- if enacted as currently drafted -- would have serious negative consequences for the chiropractic profession, including a strong negative impact at the state level.

Our concerns with H.R. 2560 are outlined in the attached analysis prepared by ACA Legal Counsel Tom Daly. Please read the analysis carefully and feel free to contact the ACA if you have any questions about the legislation. Please be advised that the ACA was not involved in the drafting of H.R. 2560. Insofar as we are aware, H.R. 2560 was developed and is being supported primarily by Dr. Rondberg's group, the WCA. We are rather sure that Representative Manzullo was not fully informed regarding the negative implications of this bill, when he was urged to introduce it by the WCA.

We strongly urge your state association take no action that would promote or support H.R.2560. Aside from bill's fatal flaws, its introduction at this time and grassroots action associated with it detracts from ACA's serious effort to enact the chiropractic pilot program (expanding chiropractic reimbursement) contained in S.1, the Senate version of the Medicare prescription drug bill now in conference with the House of Representatives.

Thus far, it appears as if H.R. 2560 has garnered little support in Congress. Nevertheless, we have supplied the legal analysis to Congressman's Manzullo's office and hope to meet with him soon so we can urge him to withdraw his sponsorship of the legislation or agree to a substantial overhaul of it, in order to address the serious concerns we have identified with the bill. If you have any questions regarding H.R.2460, please do not hesitate to contact us.

<<...OLE_Obj...>> * 1701 Clarendon Blvd * Arlington VA 22209 * Phone (703)276-8800 * Member Line (800)986-4636 * Fax (703)243-2593

* www.acatoday.com <http://www.acatoday.com>

MEMORANDUM

Odin, Feldman & Pittleman, p.c.

Cuneo Hymes Rick From: TRD Date: July 25, 2003 Re: Chiropractic Medicare Freedom and Benefit Protection Act - H.R. 2560 I have at your request reviewed the above-referenced legislation. The legislation envisions the "separate treatment of chiropractors" by the following:

1. Chiropractors would be removed from the definition of "physician" under §1861® of the Social Security Act. Also removed would be the current definition of chiropractic services, i.e. "treatment by means of manual manipulation of the spine (to correct a subluxation)".

2. "Chiropractic services" would be added as a "medical and other health services" under §1861(s)(2) of the Social Security Act and such services would be defined to include "clinically necessary care by means of adjustment of the spine (to correct a subluxation) performed by a chiropractor legally authorized to perform such adjustment by the state or jurisdiction in which such care is provided". Chiropractic services would also include physical exam, radiological examinations and specialized diagnostic instruments used in the practice of chiropractic. Such services could only be provided by a chiropractor.

3. The term "subluxation" would be defined under the statute.

4. The new chiropractic services category would be added to the definition of "physician services" under §1848(j)(3) of the Social Security Act for the purpose of calculating payment for physician services under Medicare's Resource Based Relative Value Scale (RBRVS) fee schedule.

The following analysis is based in large measure on my discussions with the chiropractic representatives to the AMA-CPT HCPAC and RUC HCPAC as well as the former chiropractic representative to RUC HCPAC. The unanimous view is that the proposed changes, if enacted, would devastate chiropractic reimbursement both within and outside of Medicare including Worker's Compensation programs, Blue Cross/Blue Shield plans, med-pay programs and all forms of third party reimbursement that in any way utilize the Medicare RBRVS system or the AMA-CPT coding procedures. In addition, the enactment of this provision would provide ammunition to those entities on a state level which would seek to either eliminate or block the ability of a chiropractor to refer to himself or herself as a "physician" and ironically serve the legislative policy goals of the American Medical Association ("AMA"). The reasons for these views are as follows:

1. The loss of the ability of a chiropractor to utilize Evaluation and Management (E & M) codes. In 2002, the AMA began a process by which it sought to develop "Evaluation and Assessment" codes for "nonphysician (sic) health care professionals". The stated objective of the AMA-CPT-5 was to "review and evaluate weaknesses of the current system for coding the provision of health services by nonphysician (sic) health care professionals". According to Dr. Craig Little, the current chiropractic representative to the AMA-CPT HCPAC, the podiatrists, optometrists and chiropractors have to date been effective in resisting the efforts of AMA-CPT to deny them the ability to utilize E & M codes because of their status as "physicians" under the Medicare statute at §1861®(3) (4) and (5) respectively. The psychologists, who currently may not utilize E & M codes, are actively seeking "physician" status within CPT in order to secure the ability to utilize these codes. The removal of doctors of chiropractic from §1861®, thereby eliminating their status as "physicians" under Medicare, will give the AMA-CPT free reign in its attempt to eliminate the ability of doctors of chiropractic to use the physician level E & M codes. In its place, doctors of chiropractic would be relegated to utilizing the non-physician level E & A codes, which will have a substantially lower relative value for RBRVS purposes. Therefore, all third party payers that utilize AMA-CPT and the Medicare RBRVS fee schedule will pay substantially less to doctors of chiropractic who may no longer use the higher valued and varied E & M codes but rather use the more limited non-physician level E & A code.

It is critical to note that the AMA has a very limited view as to the definition of a "physician." While HR 2560 is undoubtedly well intentioned, its aim of removing chiropractors from the definition of "physician" under the Social Security Act is nevertheless is in complete lockstep with the legislative goals of the AMA. Current AMA policy states:

1. H-405.988 Definition of "Physician": The AMA affirms that a physician is an individual who has received a "Doctor of Medicine" or "Doctor of Osteopathy" degree following a successful completion of prescribed course of study form a school of medicine or osteopathy. (Res. 33, A-89).

2. H-405.976 Definition of a Physician: The AMA urges all physicians to insist on being identified as a physician and to sign only those professional or medical documents identifying them as physicians. The AMA will review and revise its own publications as necessary to conform with the House of Delegates' policies on physician identification and physician reference and will refrain from any definition of physicians as health care providers. The AMA supports seeking immediate modification of the social security laws to change the definition of a physician to conform with AMA policy. The AMA will seek legislation prohibiting the use of the term "physician" as a descriptor other than in the context of a medical doctor (MD) or doctor of osteopathy (DO). (Res. 243, A-91; Reaffirmed BOT Rep. I-93-25; Reaffirmed Sub. Res. 712, I-94; Res. 241, A-97) (emphasis added)

The E & A code levels and their respected relative values have yet to be finalized by the AMA-CPT and the RUC process. However, a comparison of the existing non-physician evaluation and re-evaluation codes for physical therapists with the existing E & M codes is instructive:

E & M CODES DESCRIPTION 2003 RVU 99201 Office/Outpatient visit new 0.95 99202 Office/Outpatient visit new/expanded 1.70 99203 Office/Outpatient visit new/detailed 2.52 99204 Office/Outpatient visit new/comprehensive 3.59 99205 Office/Outpatient visit new/high complexity 4.58 99211 Office/Outpatient visit estab./min. 0.56 99212 Office/Outpatient visit estab. 0.99 99213 Office/Outpatient visit estab./expanded 1.39 99214 Office/Outpatient visit estab./detailed 2.17 99215 Office/Outpatient visit estab./comprehensive 3.18 99241 Office consultation 1.29 99242 Office consultation/expanded 2.40 99243 Office consultation/detailed 3.17 99244 Office consultation/comprehensive 4.51 99245 Office consultation/high complexity 5.85 99271 Confirmatory consultation 1.14 99272 Confirmatory consultation/expanded 1.79 99273 Confirmatory consultation/detailed 2.35 99274 Confirmatory consultation/comprehensive 3.21 99275 Confirmatory consultation/high complexity 4.05 PHYSICAL THERAPY EVALUATION AND RE-EVALUATION CODES 2003 RVU 97001 - Physical Therapy Evaluation 1.86 97002 - Physical Therapy Re-evaluation 0.99 Again, it is the view of the current and former chiropractic representatives to AMA-CPT and RUC that the loss of the "physician" status would result in the loss of the ability of chiropractors to utilize the above physician level E & M codes under the CPT system. Chiropractors would be left to use non-physician level E & A codes comparable to the above non-physician level physical therapy evaluation codes. The loss of "physician" status would also closer serve the legislative goals of the AMA rather than those of the chiropractic profession.

2. Significantly lower valuation for the new chiropractic adjustment code. The proposed legislation would change the term "manual manipulation of the spine to correct a subluxation" to "adjustment of the spine to correct a subluxation". Again, the view of the chiropractic experts working most closely with the CPT and RUC processes is that this change in statutory terminology would require a corresponding change to the CPT definition and the assignment of a new relative value in conformance with the Medicare RBRVS as provided under §1848.

In 1996, the ACA was able to achieve a major milestone for the profession by establishing a set of chiropractic manipulative treatment (CMT) codes with a corresponding relative value similar to the then existing osteopathic manipulative treatment (OMT) codes. At the time, Medicare commented that "We agree with the recommendations of the RUC HCPAC Review Board that the chiropractic manipulative treatment codes represent services and physician work that essentially parallel that of the osteopathic manipulation codes" (61 Fed. Reg. 59545, 11/22/1996). The proposed change in the statutory language would require a new definition as well as the assessment of a new relative value for the "adjustment" service. Such a process would provide an opportunity for the opponents of the chiropractic profession to argue against the implementation of the existing relative values for the CMT codes and for the implementation of lower relative values comparable to physical medicine codes. Significantly, the chiropractic profession could not use as reference the existing OMT codes, as it had done in 1996, because the definition will have been specifically changed from manipulation to adjustment. It is almost a certainty that the resulting relative values for the new chiropractic adjustment codes would be significantly less than those for the current CMT codes. This reduction in relative value would impact not only Medicare reimbursement but impact the reimbursement for every third party payer, i.e. Worker's Compensation, med-pay, Blue Cross/Blue Shield and insurance plans, that may utilize Medicare RBRVS as a guide for relative values. The impact on reimbursement across the board would be substantial and reach into the tens of millions of dollars per year for the entire profession.

3. The status of "physician" under state law. Currently, 30 states permit doctors of chiropractic to refer to themselves as "chiropractic physicians". Such status provides them important recognition and status under state law not afforded to non-physician practitioners. In 1973, chiropractors were first included in the Medicare definition of "physician". Since then this federal status has been used in many states to both obtain physician status and guard against attacks on physician status by the opponents of chiropractic. The elimination of the physician status under Medicare would be a powerful incentive for such opponents to seek corresponding loss of status in various state legislatures. The loss of such Medicare status would eliminate an important argument that doctors of chiropractors are and should be considered physicians under state law.

SUMMARY & RECOMMENDATION

The above referenced proposal, with its centerpiece recommendation to eliminate chiropractors as "physicians" under the Medicare program as well as to change the definition of the services that chiropractors provide under Medicare, would have a devastating and far reaching impact on chiropractic reimbursement both within and outside of Medicare. There simply is not a more potentially destructive step that this profession could take than to support the enactment of this proposed federal legislation. The possible negative impact of the proposed changes on the AMA-CPT process, the Medicare RBRVS process and on state authority to utilize the term "physician" cannot be over emphasized. The proposal, while seeking to create a separate and distinct yet limited (as compared to the ACA legislative proposal) category for chiropractic services under Medicare, may also severely impact those systems under which chiropractors are being reimbursed and those systems which currently recognize doctors of chiropractic as physicians.

The ACA should devote whatever effort is required to defeat this proposed legislation. ACA members should be encouraged to contact their Members of Congress in opposition to H.R. 2560 and to support ACA's legislative proposal which preserves the "physician" status and offers broader Medicare coverage of chiropractic services.

N:\DATA\client\31904\00001\trdme - 7-14-03 Cuneo-Hymes-.doc

[Guest guest]

Listees,

If you are interested there are Medicare workshops for Chiropractors being offered online. These workshops take place this month. Further information is available at http://www.noridianmedicare.com/provider/education/workshop_b.html

I am not completely familiar with the content as I have not taken them myself yet. The agenda is as follows:

Categories of Subluxation

Reasonable and Necessary Therapeutic Grounds for Treatment Maintenance Therapy Chiropractic Local Medical Review Policy Documentation Requirements

Chiropractically yours,

J. Holzapfel, D.C., Medicare CAC rep (and glutton for punishment)Albany, OR. kjholzdc@...http://docman.chiroweb.com

[Guest guest]

Howdy Don,

Actually, CAC is carrier advisory committee and I am the Chiropractic liason (no 'stinking' badges). It's made up of docs of all different persuasions and a few non-docs who meet thrice yearly to review those dreaded "Local Medical Review Policies" (LMRP) now known as "Local Coverage Determinations" (LCD). Those determinations are Medicare's policies on a given method of treatment for a condition, how it is to be coded and how it is to be reimbursed. eg. The last meeting a week ago we had a nifty presentation on vertebroplasty and kyphoplasty. Also there was discussion on professional relations, the Centers for Medicare and Medicaid Services, fee schedule, etc. Folks, after sitting through two of these now I can tell you that from the prospective of treating Medicare patients we have it easy. If you think the Medicare policies toward Chiropractors is confusing, you should get a load of those concerning our medical colleagues. Their policies can be quite confusing, contradictory and at times pit one specialty group against another. Count your blessings...

J. Holzapfel, D.C.Albany, OR. kjholzdc@...http://docman.chiroweb.com

On Thu, 12 Feb 2004 17:09:03 -0800 "Don " <dpeterson@...> writes:

what’s a CAC rep? chiro advisory committee?

-----Original Message-----From: KEVIN J HOLZAPFEL DC [mailto:kjholzdc@...] Sent: Thursday, February 12, 2004 10:03 AM Subject: RE: Medicare

Listees,

If you are interested there are Medicare workshops for Chiropractors being offered online. These workshops take place this month. Further information is available at http://www.noridianmedicare.com/provider/education/workshop_b.html

I am not completely familiar with the content as I have not taken them myself yet. The agenda is as follows:

· Categories of Subluxation

· Reasonable and Necessary Therapeutic Grounds for Treatment

· Maintenance Therapy

· Chiropractic Local Medical Review Policy

· Documentation Requirements

Chiropractically yours,

J. Holzapfel, D.C., Medicare CAC rep (and glutton for punishment)Albany, OR. kjholzdc@...http://docman.chiroweb.com

OregonDCs 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.

[Guest guest]

Hey kiddos,

Here's some news from Medicare (if you haven't received it already).

New Requirements for Chiropractic Billing of Active/Corrective Treatment and Maintenance Therapy CR3063

Chiropractors have been submitting a very high rate of incorrect claims to Medicare. Medicare only pays for chiropractic services for active/corrective treatment (those using HCPCS codes 98940, 98941, or 98942). Claims for medically necessary services rendered on or after October 1, 2004, must contain the Acute Treatmentmodifier to reflect such services provided or the claim will be denied. Click here for complete update

J. Holzapfel, D.C.Albany, OR. kjholzdc@...http://docman.chiroweb.com

[Guest guest]

Listees,

The following is some new info from Medicare:

Payment to Bank CR3079

Medicare payments may be sent to a bank (or similar financial institution) to be deposited into a provider/supplier's account so long as certain requirements are met. Click here for complete update

OIG Alert About Charging Extra for Covered Services

On March 31, 2004, the Office of Inspector General (OIG) issued an Alert that focused on physicians charging extra for services covered by Medicare. Click here for complete update

J. Holzapfel, D.C.Albany, OR. kjholzdc@...http://docman.chiroweb.com

[Guest guest]

F.Y.I. listees,

Beneficaries to Call 1-800-MEDICARE

The phone number for Medicare beneficiaries to call for Medicare questions is 1-800-MEDICARE (1-800-633-4227) as of August 15, 2004. The 1-800-MEDICARE call center representatives will connect callers to the appropriate Medicare carrier or intermediary on claim specific questions and questions that cannot be handled by 1-800-MEDICARE staff. Click here for complete update

J. Holzapfel, D.C.Albany, OR. kjholzdc@...http://docman.chiroweb.com

[Guest guest]

The following is a message I sent out to the members of the Oregon

Chiropractors Medicare Listserve. If any of you docs or your support

staff is interested in signing up for this listserve send me an email

requesting such and you will be sent an invitation to join. Thanks...

J. Holzapfel, D.C.

Albany, OR.

kjholzdc@...

http://docman.chiroweb.com

Well folks, sometimes no news is good news. Not a whole lot from

Medicare for the month of April with the exception of some reminders

concerning the Medicare Chiropractic Demonstration Project. For those of

you unfamiliar with this project Medicare chose four or five regions back

in the midwest and east to run a two year demonstration project. In this

project chiropractors are allowed to bill and receive reimbursement from

Medicare for ALL services performed. They will be reimbursed not just

for manipulation of the spine but also for EM and physiotherapy

procedures. Upon completion of this two year project Medicare will then

make a determination of whether or not this will be extended to all

chiropractic services. So keep your fingers crossed. If this works we

may someday receive reimbursement for all of our services to our Medicare

patients, not just spinal manipulation. Happy spring!!!

Holzapfel DC

Albany

[Guest guest]

Howdy Listees,

Time for a Medicare update. I know, I know, just what you wanted to

start your week with. Anyway...

1. The contractor for collecting documentation for Medicare CERT

(Comprehensive Error Rate Testing) reviews is called AdvanceMed.

Currently chiropractors have a very high error rate in Medicare claims

and the ACA Medicare Committee is working hard to bring that error rate

down. If you receive a request from AdvanceMed for patient records

supporting care rendered respond promptly and efficiently. Your response

does not violate HIPAA regulations so put the support documentation

together and send it in. Also, if you receive a request please simply

inform me so I can tabulate the request rate here in Oregon.

2. The Center for Medicare Services (CMS) has announced May 23, 2005 as

the start of enumeration for the National Provider Identifier (NPI). The

NPI is the standard unique health identifier for health care providers

adopted by the Secretary of Health and Human Services under HIPAA of

1996. The NPI replaces the UPIN and supposedly will be the identifier

that all insurers will eventually be using to identify a specific

provider, not just Medicare. Therefore, all unique provider numbers used

by other insurers to identify you, eg. Blue Cross, will eventually be

replaced by this one number. Big brother continues on. For more

information and instructions on how to apply for your NPI please see

http://www.cms.hhs.gov/hipaa/hipaa2/npi_provider.asp. Another good

source can be found at

http://www.cms.hhs.gov/medlearn/matters/mmarticles/2005/SE0528.pdf . I

enquired specifically if docs not billing electronically still need to

apply for the NPI. The response was that for now all docs should apply

even if he/she does not bill electronically (since eventually all

insurers will be using the NPI). If any info to the contrary comes up I

will forward it along.

3. Some or all of you may have received a mailing from Noridian, Oregon's

Medicare contractor, advising about a symposium on electronic Medicare

claim submission on June 9. Bold letters across the top read

" Enforcement of Mandatory Electronic Medicare Claims Begins July 5 " . For

those of you already billing electronically you have no need to fret. I

suspect there are some like myself who do not bill electronically. There

are EXCEPTIONS to this " mandatory " rule called " small provider "

exceptions. Attached is a pdf MedLearn Matter #MM 3440, dated January

2005, that lists the exceptions on page 2. A " small provider " is defined

as a physician or provider with fewer than 10 full-time equivalent

employees (FTE). A " small provider " can continued to bill utilizing

paper claims. I plan to attend the symposium (I want that laptop) so I

will keep you informed.

4. Finally, please be sure you appeal any denied claims that you believe

should have been covered as Active Treatment (-AT). If you don't that

skews the statistics which may eventually change from screens to caps

which doesn't benefit anyone but the insurer.

Sorry for the length, as always give me a hollar if you have any

questions. I will be posting this on the Medicare listserve as well.

J. Holzapfel, D.C.

Albany, OR.

kjholzdc@...

http://docman.chiroweb.com

[Guest guest]

Hi ,

I'll try to answer your questions. In item 21 of the HCFA 1500 you should enter, as primary diagnosis, the subluxation code (739.0-739.5) followed by the secondary diagnosis code. The secondary codes in Medicare are divided into Category I, II and III. Category I codes "generally require short term treatment" (as per the Center for Medicare and Medicaid Services Chiropractic Services policy). Category II diagnoses "require moderate term treatment". Category III "require longer term treatment". BUT...when you list the diagnosis reference in item 24e, "Enter the diagnosis code reference number as shown in item 21 (the diagnosis code list 1-4) to relate the date of service and the procedures performed to the PRIMARY (emphasis added) diagnosis. Enter only one reference number per line item. When multiple services are performed, enter the primary reference number for each service, either a 1, or a 2, or a 3, or a 4." Forget what you do for other insurers. Medicare is in a world (perhaps you prefer dimension?) of its own.

For example...a patient comes in with primary complaint of neck pain. Your primary diagnosis (i.e. subluxation) code is head or cervical, 739.0 or 739.1, and belongs on line #1 of HCFA 1500 item 21. Your examination determines the patient suffered a cervical sprain so your secondary diagnosis on line #2 is 847.0 which happens to be listed as a Category II diagnosis. Let's say you take x-rays and discover this patient also suffers from cervical spondylosis, a Category I diagnosis, but you feel this condition complicates this patient's condition, therefore you list it on line #3. Also, you discover degeneration of a cervical IVD so now you list 722.4, a category III diagnosis on line #4. You have described this patient's injury and any complicating issues. On line 24a you then list the date of service followed by place of service, the procedure code (98940-98943), etc. BUT, in item 24e you ONLY list one number, that is the primary diagnosis, #1, the subluxation code (because Medicare only reimbursed for manipulation of a subluxation). DO NOT list any other diagnosis code reference number.

If you are treating a patient with multiple areas of complaint and thus have more than one subluxation diagnosis code in item 21 on the HCFA, on a given date of service list only that diagnosis code which was primary on that date of service. For example, on Monday you manipulated both the cervical and lumbar regions but the cervical was the main complaint then in 24e list only the reference number pertaining to the cervical subluxation code (let's say #1). On Wednesday's follow-up you can list #1 again but let's say the lumbar was the main complaint and is diagnosis number 3, then list reference to #3's code in 24e. Whatever you do remember that in the list of diagnoses in item 21 you must have the primary subluxation code and a corresponding secondary code.

Finally, make absolutely certain your chart notes record accurately all diagnoses, even those you could not include on the HCFA for lack of space, and all justification for the services rendered. For example, your HCFA may list only two subluxation codes, but you are billing for manipulation to three regions of the spine. Your chart notes must contain the info on all areas manipulated and why to justify the services rendered.

I have copies of the billing instructions for Medicare as well as a copy of the Chiropractic Services Policy this info is taken from. I can attach a copy of the claims processing manual (PDF format) if you would like one. Let me know if I can be of any further help. You can also call me at 541-928-4060. Good luck...

J. Holzapfel DC

Albany

[Guest guest]

My God,

i'm glad to see what i'm not missing in not taking medicare.

thanks for the thorough post though Dr. Holzapfel.

Dr. ph Medlin D.C.Spine Tree Chiropractic1627 NE Alberta St. #6Portland, OR 97211Ph: 503-788-6800c: 503-889-6204

RE: Medicare

Hi ,

I'll try to answer your questions. In item 21 of the HCFA 1500 you should enter, as primary diagnosis, the subluxation code (739.0-739.5) followed by the secondary diagnosis code. The secondary codes in Medicare are divided into Category I, II and III. Category I codes "generally require short term treatment" (as per the Center for Medicare and Medicaid Services Chiropractic Services policy). Category II diagnoses "require moderate term treatment". Category III "require longer term treatment". BUT...when you list the diagnosis reference in item 24e, "Enter the diagnosis code reference number as shown in item 21 (the diagnosis code list 1-4) to relate the date of service and the procedures performed to the PRIMARY (emphasis added) diagnosis. Enter only one reference number per line item. When multiple services are performed, enter the primary reference number for each service, either a 1, or a 2, or a 3, or a 4." Forget what you do for other insurers. Medicare is in a world (perhaps you prefer dimension?) of its own.

For example...a patient comes in with primary complaint of neck pain. Your primary diagnosis (i.e. subluxation) code is head or cervical, 739.0 or 739.1, and belongs on line #1 of HCFA 1500 item 21. Your examination determines the patient suffered a cervical sprain so your secondary diagnosis on line #2 is 847.0 which happens to be listed as a Category II diagnosis. Let's say you take x-rays and discover this patient also suffers from cervical spondylosis, a Category I diagnosis, but you feel this condition complicates this patient's condition, therefore you list it on line #3. Also, you discover degeneration of a cervical IVD so now you list 722.4, a category III diagnosis on line #4. You have described this patient's injury and any complicating issues. On line 24a you then list the date of service followed by place of service, the procedure code (98940-98943), etc. BUT, in item 24e you ONLY list one number, that is the primary diagnosis, #1, the subluxation code (because Medicare only reimbursed for manipulation of a subluxation). DO NOT list any other diagnosis code reference number.

If you are treating a patient with multiple areas of complaint and thus have more than one subluxation diagnosis code in item 21 on the HCFA, on a given date of service list only that diagnosis code which was primary on that date of service. For example, on Monday you manipulated both the cervical and lumbar regions but the cervical was the main complaint then in 24e list only the reference number pertaining to the cervical subluxation code (let's say #1). On Wednesday's follow-up you can list #1 again but let's say the lumbar was the main complaint and is diagnosis number 3, then list reference to #3's code in 24e. Whatever you do remember that in the list of diagnoses in item 21 you must have the primary subluxation code and a corresponding secondary code.

Finally, make absolutely certain your chart notes record accurately all diagnoses, even those you could not include on the HCFA for lack of space, and all justification for the services rendered. For example, your HCFA may list only two subluxation codes, but you are billing for manipulation to three regions of the spine. Your chart notes must contain the info on all areas manipulated and why to justify the services rendered.

I have copies of the billing instructions for Medicare as well as a copy of the Chiropractic Services Policy this info is taken from. I can attach a copy of the claims processing manual (PDF format) if you would like one. Let me know if I can be of any further help. You can also call me at 541-928-4060. Good luck...

J. Holzapfel DC

Albany

[Guest guest]

In a message dated 9/3/2005 9:09:02 AM US Mountain Standard Time, kjholzdc@... writes:

As soon as I return to my office I can get a quote for you. It is not a big difference but one just the same

I believe the idea is that a doctor should receive less reimbursement because he has no overhead when using a hospital etc: does not pay the staff, does not pay for AC and heating, does not pay for phone lines, does not pay for power and light etc.

higher in-office reimbursement reflects the increased cost of celivering care such as the aforementioned.

Anglen

[Guest guest]

Yes, it is easy to overlook the extra $2.19 to cover our office overhead.

Anglen

In a message dated 9/3/2005 9:42:31 AM US Mountain Standard Time, kjholzdc@... writes:

Thanks , I didn't consider those differences.

J. Holzapfel DC

Albany

-- ang320@... wrote:

In a message dated 9/3/2005 9:09:02 AM US Mountain Standard Time, kjholzdc@... writes:

As soon as I return to my office I can get a quote for you. It is not a big difference but one just the same

I believe the idea is that a doctor should receive less reimbursement because he has no overhead when using a hospital etc: does not pay the staff, does not pay for AC and heating, does not pay for phone lines, does not pay for power and light etc.

higher in-office reimbursement reflects the increased cost of celivering care such as the aforementioned.

Anglen

OregonDCs rules:

1. Keep correspondence pro

[Guest guest]

They want you to take less than $24 AND go to the facility to deliver

treatment? Not me. On the other hand you could consider this your

mission, t adjust the old folks, and imagine they are hurricane

victims... Ron Johansen

On Fri, 02 Sep 2005 18:40:37 -0700 " Hartje " <billhartje@...>

writes:

> Oregon Docs,

> For those who are more knowledgeable than I about Medicare I would

> appreciate a little advice. I have been asked to treat some

> patients at a

> skilled nursing facility. After some preliminary inquiry about

> Medicare

> it was indicated DC's are reimbursed at a lower rate for " spinal

> manipulation " under Medicare at a hospital or a nursing home than

> in our

> offices. Does anyone know if this is true?

> Thanks for your help.

> Bill Hartje, D.C.

> email: billhartje@...

>

>

>

>

>

[Guest guest]

Dr. Bill,

I am not in my office so I cannot quote the exact reimbursement figure for "in facility" service but I do believe you are correct, it is less. As soon as I return to my office I can get a quote for you. It is not a big difference but one just the same. As to the purpose of the difference, who the heck knows. I generally try to avoid discerning the purpose of governmental bureacracies and their methods.

J. Holzapfel, DCAlbany

-- " Hartje" <billhartje@...> wrote:Oregon Docs,For those who are more knowledgeable than I about Medicare I would appreciate a little advice. I have been asked to treat some patients at a skilled nursing facility. After some preliminary inquiry about Medicare it was indicated DC's are reimbursed at a lower rate for "spinal manipulation" under Medicare at a hospital or a nursing home than in our offices. Does anyone know if this is true?Thanks for your help.Bill Hartje, D.C.email: billhartje@...

[Guest guest]

Thanks , I didn't consider those differences.

J. Holzapfel DCAlbany-- ang320@... wrote:In a message dated 9/3/2005 9:09:02 AM US Mountain Standard Time, kjholzdc@... writes:

As soon as I return to my office I can get a quote for you. It is not a big difference but one just the sameI believe the idea is that a doctor should receive less reimbursement because he has no overhead when using a hospital etc: does not pay the staff, does not pay for AC and heating, does not pay for phone lines, does not pay for power and light etc.higher in-office reimbursement reflects the increased cost of celivering care such as the aforementioned. Anglen

[Guest guest]

Hey, I know, maybe I can deduct that $2.19 on my income taxes...

Holzapfel

-- ang320@... wrote:Yes, it is easy to overlook the extra $2.19 to cover our office overhead. AnglenIn a message dated 9/3/2005 9:42:31 AM US Mountain Standard Time, kjholzdc@... writes:

Thanks , I didn't consider those differences. J. Holzapfel DCAlbany-- ang320@... wrote:In a message dated 9/3/2005 9:09:02 AM US Mountain Standard Time, kjholzdc@... writes:

As soon as I return to my office I can get a quote for you. It is not a big difference but one just the sameI believe the idea is that a doctor should receive less reimbursement because he has no overhead when using a hospital etc: does not pay the staff, does not pay for AC and heating, does not pay for phone lines, does not pay for power and light etc.higher in-office reimbursement reflects the increased cost of celivering care such as the aforementioned. Anglen OregonDCs rules:1. Keep correspondence pro

[Guest guest]

,

I just got back to my office this morning so now I can forward on to you the info you requested (that is assuming you still need it). The "facility setting" fees in Medicare are as follows:

Washington, Clackamas, Multnomah counties Paticipating: 98940 $22.01 98941 $31.75 98942 $42.48Non-participating: 98940 $20.91 98941 $30.16 98942 $40.36

All other Oregon locations:

Participating: 98940 $21.45 98941 $30.95 98942 $41.40Non-participating: 98940 $20.38 98941 $29.40 98942 $39.33

I hope this info is helpful.

J. Holzapfel DC

-- " Hartje" <billhartje@...> wrote:Oregon Docs,For those who are more knowledgeable than I about Medicare I would appreciate a little advice. I have been asked to treat some patients at a skilled nursing facility. After some preliminary inquiry about Medicare it was indicated DC's are reimbursed at a lower rate for "spinal manipulation" under Medicare at a hospital or a nursing home than in our offices. Does anyone know if this is true?Thanks for your help.Bill Hartje, D.C.email: billhartje@...

[Guest guest]

Listees:

Following is some Medicare information you may find helpful.

National Provider Identifier New Web Page

The Centers for Medicare & Medicaid Services (CMS) is announcing a new web page for the National Provider Identifier (NPI). This web page will contain all the latest information concerning NPI and the links, forms, instructions, timetables and late breaking news. Remember, every health care provider must obtain an NPI by law.

For more information go to:http://www.cms.hhs.gov/providers/npi/default.asp

2006 Medicare Physician Fee Schedule Not on CD-ROM

The Centers for Medicare & Medicaid Services (CMS) has decided not to place the 2006 fees on the CD-ROM this year in order to have greater flexibility of making any last minute changes to the 2006 payment rates. Placing the fees on the carrier Web site assures that providers will have the most current and correct fees available.

I will try to keep you updated when the 2006 payment rates are released.

J. Holzapfel, DCAlbany

[Guest guest]

I don't know if this went through the first time I sent it (my 'puter was acting goofy) so I am going to re-send.

National Provider Identifier New Web Page

The Centers for Medicare & Medicaid Services (CMS) is announcing a new web page for the National Provider Identifier (NPI). This web page will contain all the latest information concerning NPI and the links, forms, instructions, timetables and late breaking news. Remember, every health care provider must obtain an NPI by law.

For more info: http://www.cms.hhs.gov/providers/npi/default.asp

2006 Medicare Physician Fee Schedule Not on CD-ROM

The Centers for Medicare & Medicaid Services (CMS) has decided not to place the 2006 fees on the CD-ROM this year in order to have greater flexibility of making any last minute changes to the 2006 payment rates. Placing the fees on the carrier Web site assures that providers will have the most current and correct fees available.

I will try to keep you updated when the payment rates are finally published.

J. Holzapfel, DCAlbany

[Guest guest]

Listees,

Here is some new info from Medicare regarding the National Provider Identifier (NPI). I will follow with the yr 2006 Medicare Physician Fee Schedule for chiropractic.

National Provider Identifier - Stage 2 CR4023

During Stage 2 of the implementation of the National Provider Identifier (NPI), January 3, 2006 -October 1, 2006, Medicare systems will accept claims with an NPI, but an existing legacy Medicare number must also be on the claim. Note that CMS claims processing systems will reject, as unprocessable, any claim that includes only an NPI. Medicare will be capable of sending the NPI as primary provider identifier and legacy identifier as a secondary identifier in outbound claims, claim status response and eligibility benefit response electronic transactions.

For more information go to the following website:

http://www.noridianmedicare.com/provider/updates/docs/mm4023_use_editing_of_national_provider_identifier.pdf

J. Holzapfel DCAlbany

[Guest guest]

But , it's not just ANOTHER number, but it's THE NUMBER...that is the number that will identify us to ALL carriers...uniting us once-and-for-all in the glorious quest as we scratch and claw for the mites that our wonderful republic bequeaths to us for the priviledge of being just another miniscule cog in the grand universe of healthcare providers allowed to give of our time...WAIT A MINUTE!!! I'm getting tired. I should just leave this kind of eloquence to the experts...like Dr. Jack there in Sweet Home. Now there's a man who can wax eloquently.

HolzapfelAlbany

-- ANG320@... wrote:In a message dated 11/18/2005 11:12:25 AM US Mountain Standard Time, kjholzdc@... writes:

Medicare systems will accept claims with an NPI, but an existing legacy Medicare number must also be on the claim. Note that CMS claims processing systems will reject, as unprocessable, any claim that includes only an NPI. So what is the point - its just ANOTHER number? Anglen