Wiki New to Chiropratic billing

[bmanus]

Good afternoon,

If a chiropractor is not contracted with a Medicare managed care plan can he bill the patient instead? Since he is not contracted he can bill as a courtsey but is not held to any contractual write offs correct?

Also is it okay have Medicare patients pay for their massage therapy instead of billing Medicare if the Chiropractor suggested the service?

One more, does any one recommend any coding / billing material for chiropractic billing?


thank you in advance.

 

[ATRIBUNO]

Some info in reference to your ?

Medicare coverage of chiropractic service is specifically limited
to treatment by means of manual manipulation of the spine to
correct a subluxation (that is, by use of the hands). The patient must
require treatment by means of manual manipulation of the spine
to correct a subluxation and the manipulative services rendered
must have a direct therapeutic relationship to the patient's condition
and provide reasonable expectation of recovery or improvement
of function. MASSAGE is not a covered service and would require an ABN - to inform the patient of same.

I do not know if a DC can not bill Medicare if they are not a Medicare provider - either participating or not participating. May I suggest you contact CMS for a formal answer.

 

[ATRIBUNO]

Billing/Coding

May want to contact HJ Ross for thier billiing/coding seminar program locations. You can find their contact info via the internet.

 

[ejlehman]

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 be bill for spinal manipulation is if there are non par benefits through that plan and the patient requests it. An ABN is only required for CMS if you are contracted. An ABN does not need to used for managed Medicare plans unless the payor has required it, and then it must be one from the payor or approved by CMS to be used for that carrier. Massage is not a payable under Medicare and would probably fall under the same for Managed plans. Check you local jurisdiction guidlines to make sure.