Wiki Medicare onset date

[Sephardic]

I'm in need of some help with understanding the Medicare onset date for chiropractic claims. Having an issue here in my office. Not sure if there's anything fraudulent going one (not on purpose) but it just doesn't seem right. I don't code for these services but we have 2 billers that handle that account.

When we get the providers superbills on his Medicare patients he is writing down a new onset date for them every time. On the superbill it always gets changed to the date of service. From what I understand of Medicare's policy the onset date can be changed if the patient experiences an acute exacerbation. I'm assuming that these patients are experiencing an acute exacerbation. My problem is we get a spreadsheet from the office and this also has the onset date listed on it and this I'm being told is from the medical record. These dates don't always match the onset date of the superbill (which is always put down as the DOS)

If an established Medicare patient has an exacerbation on say the 19th of the month but can't get into the office until the 24th. What onset date should we be using? The 19th or the 24th?

I think it's odd that it gets changed every visit at any rate let alone the fact that we're not sure what date to use. I think one of our billers gave him some bad info. Any thoughts or comments would be appreciated

 

[ejlehman]

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, and it is not maintenance, then a new injury onset date must be used. If it is known, you can use it, but generally the onset date matches the date of initial treatment. As expected, the documentation must support the dates. Any variance in the record, is an audit flag!

 

[teresabug]

I agree with Elizabeth. I billed for PT for a few years and we used the date of the initial eval for the onset date. If this date gets changed at every visit, it is changing the end date of when a patient can receive their last treatment for those patients whose coverage is based on 60 consecutive days of tx.

 

[CULINTZ]

I'm looking for particular references on this subject. Can anyone refer me to CMS or other billing guidelines on this? I'm in Ohio. Thanks