The Centers for Medicare and Medicaid Services (CMS) provide an explanation for eight frequent misconceptions concerning Medicare chiropractic billing services. Read the entire article for additional information and depth.

Misconceptions Regarding Chiropractic Billing Services

Misconception 1. There Is a 12-Visit Cap or Limit for Chiropractic Billing Services 

Fact: There are no limits or caps in Medicare regarding the coverage of chiropractic billing services care provided by chiropractic care providers. As long as they follow and meet Medicare’s licensure.

Misconception 2. Non-participating Providers Don’t Need To Get Worried About Billing Medicare 

Fact. Just because you are not participating then it doesn’t mean that you don’t have to pay the bill to Medicare. All of the Medicare part b covered services must bill to Medicare by the provider. Else the providers have to face the penalties. This is a Mandatory Claim Submission Rule.

There is one exception to this rule is when the beneficiary has signed a valid Advance Beneficiary Notice of Non-coverage (ABN). From the CMS-R-131 option 2 was selected.

Misconception 3. If You Are Non-Participating Provider, You Will Never Be Audited nor Have Claim Reviews 

Fact. Any Medicare claim submitted can be reviewed and audited. The provider’s participation status doesn’t affect this occurrence. CMS audits and reviews are intended to protect the Medicare trust funds and also for the identification of billing errors so providers and their billing staff can be alert of errors and educated on how to avoid errors in the future.

Correct coverage, reimbursement, and billing requirements are available to help you out in understanding Medicare requirements and chiropractic billing services.

Misconception 4. You Can opt Out of Medicare 

Fact. Doctors of Chiropractic Billing Services may not opt out of Medicare. But need to understand that opting out and not participating is not the same. Chiropractors may decide to be participating in Medicare, but they may not opt out. Opt-out refers to a physician’s ability to decide not to bill Medicare at all after which they serve Medicare patients through private agreements.

Medicare does not cover the services provided under these private contracts that satisfy the opt-out standards, and Medicare does not pay for those treatments.

Misconception 5. Each patient should have an Advance Beneficiary Notification (ABN) signed once, as it will be used for all visits and services.

Fact. You must predict that Medicare and chiropractic billing services will not pay for a specific service because it will not be deemed medically reasonable and required in this case before you decide to deliver an ABN to a beneficiary. The beneficiary can then use the ABN to make an educated choice about using and paying for the service.

Before signing the ABN, the beneficiary must select one of the three choice boxes for the ABN to be regarded as a legally binding notification of liability. See the CMS fact page for further information on these three choice boxes. An ABN is given each time a patient receives a Medicare-covered service that the physician suspects might not be deemed medically reasonable and necessary and, as a result, not be reimbursed by Medicare, according to the CMS.

A patient who receives the same service repeatedly on an ongoing basis from a provider may receive a single ABN from that provider. The precise service(s) and frequency of delivery must be specified in ABNs for recurring services. A new ABN must be obtained if the same service is delivered for a period longer than a year or if the service offered changes. For additional details about ABNs.

Misconception 6. Medicare Does Not Cover Maintenance Care as a Service.

Fact. Medicare covers spinal manipulation as a covered service. But, Medicare does not deem maintenance treatment to be medically reasonable and essential and does not reimburse for it. Only acute and ongoing spinal manipulation treatments qualify as active care and are therefore eligible for reimbursement.

Misconception 7. The Documentation Requirements for Non-par Providers Are Different from Those for Par Providers.

Fact: Some records must be kept for chiropractic care. The documentation requirements are independent of the provider’s participation status.

Misconception 8. The DME that DC orders will be paid for by CMS.

Fact: If a chiropractor has a current supplier number provided by the National Supplier Clearinghouse, they may function as suppliers of durable medical equipment (DME), but they will not be compensated if they place an order for DME. This occurred in Chiropractic billing services.

The Centers for Medicare and Medicaid Services (CMS) outline eight common misconceptions about Medicare chiropractic billing services, along with an explanation. For more detail and information, read the whole article.

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