Search results

  1. E

    Humana denials

    Humana never paid exams for us. They always told us "they follow Medicare guidelines" for E/M.
  2. E

    Does anyone know of any chiropractic seminars ?

    Both Chirocode and Chirotouch offer webinars that are very up to date and informative.
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    Sample claims

    I am teaching a Health Insurance and Reimbursement course at YTI and am looking for some sample notes/insurance info for students to practice filling in the claim forms. I can only do so much from my office as I am in a specialty so am looking for a variety of types of cases, payers, etc. We...
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    Template for 98940-98943 Medicare

    Check your local LCD. Also check for your EHR guidelines if that is what you are using. With the upcoming changes for 2017, you're going to want to know.
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    Chiropractors Billing Massage

    We have a LMT in our office and none of the payers will pay for it when she bills. They will let the patient use their HSAs for the massage. Stick to your guns. If need be, contact the insurance company and have them send out guidelines that you can copy to your patient.
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    E/M with CMT

    If you are billing E/M with a CMT code, it must be for a new condition or a recurrence with acute onset. Make sure you bill with a modifier. If more than 50% of the visit is spent in counseling, then you can bill an E/M as long as you document the time factor. The CMT code normally includes...
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    Chiropractors

    You can bill but it will be denied as Medicare does not pay it. I will bill for it so that when it crosses over to the secondary (and especially if the secondary pays for it) it is there without doing a separate billing. Many of our patients want to see that denial before they will pay it out...
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    Aetna and denials for ICD-10

    Not all claims. I am in chiropractic so I use the M99 codeset per CMS and LCD guidelines. I have some that have gone through without an issue but I have more that are being denied. I cannot seem to get a straight answer when I call about them. So frustrating.
  9. E

    Aetna and denials for ICD-10

    Is anyone else having issues with ICD-10 and Aetna? I am in Pennsylvania and we keep getting denials for incorrect coding. I know they are the right codes as no one else is denying them. Any insight would be great!
  10. E

    New to Chiropractic

    Did he use the modifier -AT? Does he have an ABN on file for those patients? He can appeal for a code 50.
  11. E

    Resources for Chiropractic care

    CMS has a list of ICD-10 codes that are accepted (much like the list that they provided for ICD-9). Chirocode has a bunch of great webinars that will help. Also the state chiropractic association should have something available. I know we are having issues with Aetna and ICD-10 but all other...
  12. E

    auto accident and transportation

    Check your state laws regarding this. Each state is different.
  13. E

    Orthotic Billing For a Chiropractor

    We bill for orthotics in our office. Check with your payer to make sure it is payable to your office or how it should be billed. Make sure your dx supports the need for orthotics (usually unequal leg length).
  14. E

    documentation requirement for CPT 98941

    With the coming of ICD-10, it is best to encourage the doctor to be specific and document where he is adjusting (region, vertebra, and direction). I have had a few audits that this has been questioned. Many payers are asking for notes more and more and it is best too have too much than too little.
  15. E

    bundling?

    We bill 98941 and 98943. No modifier unless it is Medicare. Medicare does not pay for extra spinal and some insurance companies do not also. Check your contract and guidelines.
  16. E

    Doctor taking home the mail with the ins cks

    I have experienced this with the office manager doing this on the days I am not here. I have managed to get the front desk people to pull my carrier and patient checks and put them in my bin when they bring the mail in. But I agree, it is their practice and there isn't much you can do except...
  17. E

    Aetna's aquisition of Coventry

    Has anyone heard about how this is going to affect Health America plans who use Coventry? I can only find information in regards to Medicaid so far.
  18. E

    Medicare onset date

    You must demonstrate that the Medicare patient has an acute injury status or chronic condition, and not maintenance. If the patient is being seen within 30 days of the last visit, and it is a follow up visit, the injury date would not change. If it is more than 30 days since the last visit...
  19. E

    Active Release Technique ( ART )

    I check with the carriers for which codes they will accept with documentation. Some will take 97530 and some will not. There are a few who will not pay 97140. We have also talked with Dr. Leahy's office about which codes we should use for ART and just how to document it correctly.
  20. E

    Therapeutic Procdures.

    Code 97110- Therapeutic procedure, 1 or more areas, each 15 minutes; therapeutic exercises to develop strength and endurance, range of motion and flexibility. 97530 is one on one. 97110 can be used if the patient is doing stretches or exercises under supervision. Both are timed codes. As...
  21. E

    learning resources for chiro

    Chirocode.com offers weekly webinars. If you become a member, you can access previous webinars and Q&A. They also offer a book specific to billing and coding for chiropractic full of tips. It's free to sign up for their email newsletters and to join the live webinars.
  22. E

    Does this note justify E&M and adjustment

    Definitely 2 regions. I would probably bill a low level exam.
  23. E

    Chirohealth usa

    We started using it several months ago. It was a long process to get enrolled. Almost all of our patients who have enrolled in it have appreciated the fact that they are saving money, especially if they are coming in frequently for care. If they are a seasonal patient, we don't recommend it...
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    ABN Requirement?

    I just went through an audit in our office (I bill for a chiropractor). You must have an ABN on file for the Medicare patient when billing for chiropractic unless it is maintenance care (remember to use the proper modifiers) . They will deny if not.
  25. E

    Chiro & pt billing

    Check with your carriers for guidelines. You should be able to bill both as it was provided by two different providers.
  26. E

    HCFA 1500 20-12 FORM and Medicare

    If you bill for any date of service, you must use the new form if you are submitting the claim after April 1. The issue that we seem to be having is the group NPI vs the rendering physician NPI and what they are recognizing on the new form in their system.
  27. E

    HCFA 1500 20-12 FORM and Medicare

    Has anyone else received denials regarding the new HCFA form? We started using the new form in March and are getting denials from Medicare stating that the provider information is missing or incomplete, but it is in the proper boxes. We are not having this issue with any other payers as of yet...
  28. E

    Medicare- Multiple Primary Diag Codes?

    Yes you can. Just make sure you include a secondary dx.
  29. E

    Active Release Technique ( ART )

    I am in Millersville, PA. We use 97530 for ART. We include in our notes when requested, the muscles affected as well as time. The Chiropractor I work for is ART certified. This technique is separate from a manipulation.
  30. E

    Negotiating Payer Contracts

    Not sure if this is the right place to put it, but I'll ask. What type of formula or what are you using to base your fee schedules on when negotiating the payer contracts. Some payers allow you to negotiate for a higher rate (not Highmark!) so we are trying to figure out some kind of base to...
  31. E

    98941-at

    Per Medicare Guidelines (And I would get to know your LCD), you must have a dx for the subluxation or primary, which is the 739.x code set, otherwise you will get denied. 721.x is a secondary dx. Good luck!
  32. E

    98941-at

    Per Medicare Guidelines (And I would get to know your LCD), you must have a dx for the subluxation or primary, which is the 739.x code set, otherwise you will get denied. 72.x is a secondary dx. Good luck!
  33. E

    -25 Modifier on all E/M procedures

    If you are just billing an exam (99203) with no adjustment (98941), you do not need the modifier. The only reason you would use the modifier is to break the NCCI edit.
  34. E

    Denied claim d/t diagnosis problem

    More than likely it is a glitch in their system. We have been having lots of issues with those lately.
  35. E

    G0283 - physical therapists

    You can use it on Medicare claims otherwise you will get denials.. Some payers like United Healthcare like it better than 97014 or 97032 as it is more specific. Check with the payor to see which code is preferred.
  36. E

    Hand held sports massager

    You could use 97124 with a modifier of 59 if done on the same day as a manipulation. Be prepared to document. It also depends on who you are billing. Some carriers do not pay for it.
  37. E

    E/M codes for chiropractic

    We bill the same E/M codes. Just remember modifiers if you bill with an adjustment.
  38. E

    New Guidelins for Myofacial Release with Adjustments?

    My doctor does ART with his adjustments. Most payers will reimburse as long as I include notes as to which muscles he worked. Check with your carrier. It must be billed under a therapy code- we use 97530 or 97110, depending on the carrier.
  39. E

    New to Chiropratic billing

    If you are non par with Medicare, you do not need to bill Medicare. Medicare only pays if you are par and for spinal maipulation only (as long as it is not deemed maintainence care). The same goes for managed Medicare-type plans as they follow Medicare guidelines. The only time you may want to...
  40. E

    ulnar nerve subluxation

    I have used 354.2 Lesion of Ulnar nerve (cubital tunnel syndrome).
  41. E

    59 modifier - I know nothing when it comes to billing for chiro

    I would bill a 97112-59 instead for the therapy performed.
  42. E

    Chiropractor xrays for Medicare!

    Medicare will not pay for Xrays billed by a chiropractor but the Ortho can bill for the technical under Medicare Guidelines.
  43. E

    coding ART for chiropractic

    We actually have started using 97110 instead. As long as I can document time, it seems to be working.
  44. E

    Lordosis

    738.2?
  45. E

    medicaid refund

    You need to notify Medicaid that it was billed incorrectly and submit a corrected claim. They will send you a request for refund. I am assuming it works the same as it does for me in PA. Good luck!
  46. E

    How many days do providers have to amend??

    I have learned with one of my doctors to meet with him on a regular basis and go over his documentation when it does not support the level of service originally billed. I have given him deadlines for changes so that we do not have this type of discussion. Per a conversation I had with a CSR at...
  47. E

    Loss of Lordosis coding

    I am thinking more info is needed on this one. "Loss of" indicates that the curvature is being corrected in some way. We use 737- 737.9 depending on type or 738.5 if it is NOS. If the curvature is gone, we do not code it. Good luck!
  48. E

    Medicare - Can anyone help

    I would call Medicare or check the website. If the denial is unclear, always call. Never hurts and you could find out in one shot the reason for denial and what you need to do to correct it.
  49. E

    HCPCS codes for anti inflammatory gels

    Hopng someone can give me a suggestion of two. We have billing anti inflammatory gels that we give to patients for home use between visits as A9270. I have been told that some WC and Auto will pay for them. I am racking my brain trying to find a correct code to bill. Of course the WC and...
  50. E

    Billing with a modifier for ExtraSpinal

    My doctors are now doing ExtraSpinal Manipulations (98943) as well as regular spinal manipulations. Should I attach a modifier to 98943? I have linked the specific ICD-9 code.
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