Medicare question

[Guest guest]

Dear Minga

You do not have to build Medicare under the circumstances. Have the patients

sign an advance

beneficiary notice. Form No. CMS-R-131-G

Rodney Cross

medicare question

> dear listservmates,

> I have a question on medicare billings. If a patient has a private HMO

type

> of medicare with no chiro coverage at all, do we still have to bill

medicare.

> We've been doing it and getting the denial, then we bill the patient. All

> this turnaround takes too much time to get payment. What's the concensus?

To

> bill or not to bill that is the question.

> Minga Guerrero DC

> Portland OR

>

> 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]

Ted,

It seems very odd that the Medicare Administration would discontinue the

provider number they assign you. That is how they identify you. Have

you contacted them directly and inquired as to why your provider number

is no longer valid? My understanding is that as Chiropractors we cannot

opt out of Medicare like the medics can. We can be non-participating,

but we cannot refuse to treat Medicare patients altogether. Someone

correct me if I have my facts screwed up.

J. Holzapfel, D.C.

Albany, OR.

kjholzdc@...

http://www.docman.chiroweb.com

[Guest guest]

Actually ORS allows us to be able to choose our pts. not medicare!

Dr. Charlie Caughlin DC

155 NW 1st Ave

Day, Or 97845

off 541-575-1063

hm 541-575-1103

fax 541-575-5554

----- Re: Medicare Question

> Ted,

>

> It seems very odd that the Medicare Administration would discontinue

> the provider number they assign you. That is how they identify you.

> Have you contacted them directly and inquired as to why your

> provider number is no longer valid? My understanding is that as

> Chiropractors we cannot opt out of Medicare like the medics can. We

> can be non-participating, but we cannot refuse to treat Medicare

> patients altogether. Someone correct me if I have my facts screwed

> up.

>

> J. Holzapfel, D.C.

> Albany, OR.

> kjholzdc@...

> http://www.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]

Ted,

My got all screwed up because I was originally assigned a number when I used my soc. security number as a sole proprietor. When I became a corporation and began billing with a Tax ID number, Medicare would kick things back to me. I've had to recently do the whole application process again and get re-assigned a new number. I became a corporation 10 years ago, and they are just coming up with this now. So, it is different than your situation, but I can empathize with the frustration.

Don WHite, RN, DC

[Guest guest]

In a message dated 8/21/03 2:50:12 PM Central Daylight Time,

kjholzdc@... writes:

<< We can be non-participating,

but we cannot refuse to treat Medicare patients altogether >>

We can refuse to treat anyone we want. Here in Arizona a number of years back

they switched the number system they used for Medicare and I had to reapply

for a new number under their new system.

Anglen

[Guest guest]

,

We were told the number had expired.

Ted

On Wed, 20 Aug 2003 11:45:58 -0700 J Holzapfel DC

<kjholzdc@...> writes:

> Ted,

>

> It seems very odd that the Medicare Administration would discontinue

> the

> provider number they assign you. That is how they identify you.

> Have

> you contacted them directly and inquired as to why your provider

> number

> is no longer valid? My understanding is that as Chiropractors we

> cannot

> opt out of Medicare like the medics can. We can be

> non-participating,

> but we cannot refuse to treat Medicare patients altogether.

> Someone

> correct me if I have my facts screwed up.

>

>

> J. Holzapfel, D.C.

> Albany, OR.

> kjholzdc@...

> http://www.docman.chiroweb.com

>

>

[Guest guest]

Just for a word on the confusing world of Medicare, recall two stories from last summer:

at the same time, 2 different colleagues told their little time-waster:

One had been billing Medicare since the 60s with the same number. Then suddenly they started kicking back all his claims for 6 months......Finally they told him (after a lot of calls, etc) that he had to re-apply, as his claim number was wrong.....the "0" he had used on the typewriter for 30+ years looked too much like "O".......

another DC who NEVER has made a Medicare claim was told he had to file for a new number because his old one was out of date.......of course he didn't hurry to comply, they hassled him about it, he told them he was uninterested in their problem and to quit bothering him.....last I heard he hasn't been hauled off yet........

J Pedersen, DC

Re: Medicare Question

Ted, My got all screwed up because I was originally assigned a number when I used my soc. security number as a sole proprietor. When I became a corporation and began billing with a Tax ID number, Medicare would kick things back to me. I've had to recently do the whole application process again and get re-assigned a new number. I became a corporation 10 years ago, and they are just coming up with this now. So, it is different than your situation, but I can empathize with the frustration. Don WHite, RN, DC 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]

Ok, but now Don....now that Medicare has finally got your Corp., situation straight...now you must be making some really big bucks via Medicare no?

Couldn't resist that one bud!

Vern Saboe

Re: Medicare Question

Ted, My got all screwed up because I was originally assigned a number when I used my soc. security number as a sole proprietor. When I became a corporation and began billing with a Tax ID number, Medicare would kick things back to me. I've had to recently do the whole application process again and get re-assigned a new number. I became a corporation 10 years ago, and they are just coming up with this now. So, it is different than your situation, but I can empathize with the frustration. Don WHite, RN, DC 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]

We had the same "O" vs "0" issue as well one or two years ago. We went to the wall with them as nothing had changed in our system, printers, etc. We had to hand circle some "0's" on a bunch of bills in queston. We changed nothing and they have been fine so far. I think it was just another method of stalling / bean counting...........

P. Thille, D.C., FACORedmond, Oregon

Re: Medicare Question

Ted, My got all screwed up because I was originally assigned a number when I used my soc. security number as a sole proprietor. When I became a corporation and began billing with a Tax ID number, Medicare would kick things back to me. I've had to recently do the whole application process again and get re-assigned a new number. I became a corporation 10 years ago, and they are just coming up with this now. So, it is different than your situation, but I can empathize with the frustration. Don WHite, RN, DC 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]

robert

i did ..... my only insurance for my second CI was medicare .... approved and

very quickly too

good luck

susan

[Guest guest]

Keep trying , I'm sure you will be successful.

Regards/

Jerome

Medicare Question

Ok, need to know. How many have gotten approval for bilateral with

Medicare coverage _anly_? My audie has his doubts. He doesn't know I am

not going to settle for a " No " . LOL

*---* *---* *---* *---* *---*

Are you still here? The message is over. Shoo! Go away!

& Gimlet (Guide Dawggie)

Portland, Oregon

N24C 3G 8/2000 Hookup

rlclark77@...

http://home.comcast.net/~rlclark77/

[Guest guest]

,

Was the process any different from the first? I dont know if my

audie has done bilateral here, should ask him. Apparently he has not

done bilateral with Medicare.

*---* *---* *---* *---* *---*

I started out with nothing and still have most of it left.

& Gimlet (Guide Dawggie)

Portland, Oregon

N24C 3G 8/2000 Hookup

rlclark77@...

http://home.comcast.net/~rlclark77/

[Guest guest]

,

Medicare will pay for mappings as well. 80% so remember that. If

you can also get supplemental, all the better.

*---* *---* *---* *---* *---*

Do not mistake bribe-taking for corruption.

--Vladimir Rushaylo, Russian interior minister

& Gimlet (Guide Dawggie)

Portland, Oregon

N24C 3G 8/2000 Hookup

rlclark77@...

http://home.comcast.net/~rlclark77/

[Guest guest]

,

That's good to know, thanks, and I was aware of the 80/20 situation.

My question is this: I have been looking into various supplemental

coverages, but none of them specifically mention implants or

mappings, etc. So how will I know if they cover the remainder or if

there is a co-pay involved for mapping visits?

Hmmm . . . let me guess, I need to call them, right? Ha ha.

Still looking for info if anyone has it about whether NYU or Beth

Israel accept Medicare?

Thanks,

> ,

> Medicare will pay for mappings as well. 80% so remember that.

If

> you can also get supplemental, all the better.

>

[Guest guest]

,

I imagine the 2 centers involved do accept Medicare. but you should call

them to ask.

I did want you to be aware of a developing center in NY.

In June, Dr. Simon Parisier left Manhattan Eye and Ear and went to New York

Eye and Ear Infirmary with his implant team. They moved into a new facility. I

forgot the name offhand of the director of the new center but she is a PHd

audie who I believe is from Beth Israel. I was told that in January, the

entire CI staff from Beth Israel will be joining them and it will be the largest

implant center in the Northeast.

Steinerman

[Guest guest]

Thanks, ; this is good information!

> ,

>

> I imagine the 2 centers involved do accept Medicare. but you

should call

> them to ask.

>

> I did want you to be aware of a developing center in NY.

>

> In June, Dr. Simon Parisier left Manhattan Eye and Ear and went to

New York

> Eye and Ear Infirmary with his implant team. They moved into a new

facility. I

> forgot the name offhand of the director of the new center but she

is a PHd

> audie who I believe is from Beth Israel. I was told that in

January, the

> entire CI staff from Beth Israel will be joining them and it will

be the largest

> implant center in the Northeast.

>

> Steinerman

>

>

>

>

[Guest guest]

Hi , Beth Israel does CI Surgery? I thought the 2 in Boston were MEEI and

CHidlren..thats great!

Re: medicare question

,

That's good to know, thanks, and I was aware of the 80/20 situation.

My question is this: I have been looking into various supplemental

coverages, but none of them specifically mention implants or

mappings, etc. So how will I know if they cover the remainder or if

there is a co-pay involved for mapping visits?

Hmmm . . . let me guess, I need to call them, right? Ha ha.

Still looking for info if anyone has it about whether NYU or Beth

Israel accept Medicare?

Thanks,

> ,

> Medicare will pay for mappings as well. 80% so remember that.

If

> you can also get supplemental, all the better.

>

[Guest guest]

I'm not looking for surgery, I am looking for mappings, and I will be

in NY, not Boston. Sorry if there was any confusion!

> Hi , Beth Israel does CI Surgery? I thought the 2 in Boston

were MEEI and CHidlren..thats great!

[Guest guest]

oops..good luck :-)

Re: medicare question

I'm not looking for surgery, I am looking for mappings, and I will be

in NY, not Boston. Sorry if there was any confusion!

> Hi , Beth Israel does CI Surgery? I thought the 2 in Boston

were MEEI and CHidlren..thats great!

[Guest guest]

,

Box 24e should contain only that reference to the one primary subluxation code,

that is diagnosis number 1 (of the four spots available on the HCFA 1500). If

you are adjusting more than one region of the spine then your chartnotes will

contain the necessary diagnosis codes for the remaining regions being adjusted.

Your notes support the level of service being billed, not just the HCFA. eg. My

patient's primary complaint is cervical, but secondarily I am also adjusting

thoracic, lumbar and pelvis. 24e only contains the reference to the cervical

subluxation as long as that is the primary focus for that visit. But my notes

also make reference to the thoracics, lumbars and pelvis so I bill 98942. The

fours spots on the HCFA may only contain reference to two spinal regions because

I am also including secondary codes (eg. 722.52 or 722.4). I have done this for

years and each time I have received any kind of denial once I follow up with

providing a copy of my notes I have received payment. If you like I can send

you a copy of the Medicare billing manual. It also explains the entry in 24e.

BTW Try not to search for the logic in Medicare practices. It's difficult at

best sometimes. I hope this has been helpful.

Holzapfel DC

Albany, OR.

[Guest guest]

Hi....you are correct....if you have been disable for more than 2 years

medicare kicks in automatically....it covers usually 80% of surgery

and you or your co insurance will be responsible for the rest of the

bill.

Medicare cover all hip replacements whether they be anterior, posterior,

or anterolateral etc. The entrance does not make a difference. Also hip

resurfacing was recently approved by the FDA but Medicare cover this

procedure even before the FDA approved it!!!!! I had my right hip

resurfaced by Dr. Amstutz on 8/29/06 and Medicare picked up even more

than 80%. The only problems you might run into is, some docs do not take

Medicare because it pays such a paltry sum.....

[Guest guest]

Thank you ! I appreciate it.

Rick

Re: Medicare Question

Hi....you are correct....if you have been disable for more than 2 yearsmedicare kicks in automatically....it covers usually 80% of surgeryand you or your co insurance will be responsible for the rest of thebill. Medicare cover all hip replacements whether they be anterior, posterior,or anterolateral etc. The entrance does not make a difference. Also hip resurfacing was recently approved by the FDA but Medicare cover this procedure even before the FDA approved it!!!!! I had my right hipresurfaced by Dr. Amstutz on 8/29/06 and Medicare picked up even morethan 80%. The only problems you might run into is, some docs do not takeMedicare because it pays such a paltry sum.....

[Guest guest]

Hi Ron,

I'm not sure just what you mean by "the 5th diagnosis"...do you mean a fifth diagnosis code? If so, up to eight codes can go on a claim form. Codes 5 through 8 go in box 19, each separated by a comma. The codes in box 19 should not be codes required for payment. If more than four codes are required for payment a second claim form must be submitted with the additional required codes. Does that help?

-- "rongrice01" <rongrice@...> wrote:

,We were wondering if we needed to put the 5th diagnosis on the HCFA billing form when billing for a 98941? I know there was talk about this but was not sure if it was just a rumor or fact. Any help from your expert perspective would be greatly appreciated. Grice, DCAlbany, OR

[Guest guest]

My experience was when I replaced my sound processor, I paid for it

and sought Medicare reimbursement. Medicare contracting processor

informed me that it must initiated by the provider. The Provider did,

and Medicare informed that it must be done by electronic. So I went

back to the provider. That was only late last week. In my situation, if

Medicare pays, then Tricare-for Life would pay the deductible and

copayment. I also asked the audiologist to submit a " medical

necessity " statement.

Alfred Tsang

******************************

On Nov 20, 2007, at 10:17 AM, C J wrote:

> Does anyone know what the Medicare codes are for Cochlear Implant

> replacement parts and batteries. I was denied coverage for coils,

> batteries, and microphone covers by my insurance company because

> Cochlear is not a participating provider, however, coverage is given

> if Medicare covers it but I neet the codes.

>

> Thanks and Happy Thanksgiving!!!

>

> Connie

>

> " The Miracle at Ohio State "

> aka Nucleus Freedom

> Bilateral Implants

> 1st Implanted 10/04/2005

> 1st Activated 11/1/2005

> 2nd Implanted 03/06/2007

> 2nd Activated 05/08/2007

> Surgery: Ohio State University

> Surgeon: Dr. Bradley Welling

> http://internalmedicine.osu.edu/article.cfm?ID=2021

>

>

[Guest guest]

I found this site recently while looking for some info for myself it

none else has the codes for you some information here might be

helpful

http://www.cochlear.org/sys-tmpl/medicareandcochlearimplants/

>

> Does anyone know what the Medicare codes are for Cochlear Implant

replacement parts and batteries. I was denied coverage for coils,

batteries, and microphone covers by my insurance company because

Cochlear is not a participating provider, however, coverage is given

if Medicare covers it but I neet the codes.

>

> Thanks and Happy Thanksgiving!!!

>

> Connie

>

>

> " The Miracle at Ohio State "

> aka Nucleus Freedom

> Bilateral Implants

> 1st Implanted 10/04/2005

> 1st Activated 11/1/2005

> 2nd Implanted 03/06/2007

> 2nd Activated 05/08/2007

> Surgery: Ohio State University

> Surgeon: Dr. Bradley Welling

> http://internalmedicine.osu.edu/article.cfm?ID=2021

>

>