b'ComplianceLEGAL NUTRITIONCouncilANJC Leadership ANJC Leadership LEGAL EASE NUTRITION REHAB Council Executive Directors UPDATE LEGAL Q&A CHIROASSISTINSURANCE Update INSURANCE Update Legislative UpdateTECHNIQUE Councilnon-participating with Medicare and this MA plan. MedicareQ&AWhen the patient received the EOB, the plan did pay towards the services at their fee schedule butOUR HEALTHstated that the patient was not responsible for the By Dr. Richard C. Healydifference between my billed charge and their fee ANJC Medicare Consultant schedule. I thought as a non-par provider with this plan I could charge my customary fee. Do I have to QDo I have to bill Medicare for the CMT code if it isrefund the patient?maintenance care?Yes, but there are a few exceptions. The MandatoryATypically, if you are non-participating with the MA A plan, you would collect from the patient the co-pay Claims Submission component of the Socialor co-insurance amount at the time of service. For Security Act Section 1848 (g) (4) requires thatcovered services, the MA plan is obligated to pay claims be submitted for all Medicare patients forthe difference to the provider up to the limiting services rendered on or after Septempter 1, 1990.charge.This requirement applies to all physicians and The issue, however, may be how you filled out the suppliers who provide covered services to Medicare beneficiaries.1500 form. Check to see if you accepted assignment The key wording here is providing coveredin box 27 of the 1500 form. If it is checked Yes, then the EOB is correct and you must refund the services to Medicare beneficiaries. One may arguepatient. Once you accept assignment, you have that maintenance care is not a covered service.agreed to accept the Medicare-approved amount as However, according to CMS, the 98940, 98941 andfull payment for any covered service provided to a 98942 CMT codes are always covered services.Medicare patient.They are just not always reimbursable services. Maintenance care utilizing the CMT codes is an example of a non-reimbursable service. Richard C. Healy, DC, CCSP, is the treasurer and Medicare The exceptions to adhering to the Mandatory consultant for the ANJC. A New Jersey Medicare Carrier Advisory Committee delegate and a Certified Chiropractic Claims Submission Act would be: Insurance Consultant, Dr. Healy is a graduate of New YorkThe patient directs you not to bill Medicare asChiropractic College and has been in private practice indocumented by the patient choosing Option #2 Dumont for more than 35 years. on the ABN form prior to the service. Medicare Secondary Payer (MSP) claims when you do not possess all the information necessary, the nations leading to file a claim malpractice insurance companyServices that are furnished for freeI TST I M EF O RA QDo I have to bill Medicare for non-covered services,COVERAGE ADJUSTMENT like examinations and physical medicine modalities?A No, but once again there is an exception. AccordingTo receive a free quote and learn more aboutto the CMS Local Coverage Article for ChiropracticMedPros ChiroPreferred program, call your local MedPro agent today.services, Excluded from Medicare coverage888.MEDPRO5CHIROPREFERRED.COMis any service other than manual manipulationMedPro Group is the marketing name used to refer to the insurance operations of The Medical Protective Company, Princeton Insurance Company, PLICO, Inc. and MedPro RRG Risk Retention Group. All insurance products are administered by MedPro Group and underwritten by these and other Berkshire Hathaway affiliates, including National Fire & Marine Insurance Company. Product availability is based upon business and regulatory for the treatment of subluxation of the spine.approval and may differ among companies. Visit medpro.com/affiliates for more information. 2018 MedPro Group Inc. All Rights Reserved. The chiropractor is not required to bill excluded services.Here comes the exception:However, if the beneficiary requests Medicare bebilled, the provider must bill services to Medicare in order to obtain a denial for secondary insuranceSUPPORTS DISC AND purposes. Once again, it comes down to theCONNECTIVE TISSUE HEALTHpatients directive.QI recently submitted a claim for physical medicine modalities to a Medicare Advantage plan. When we checked for eligibility and benefits, we were told because the patient has extended chiropracticTo order please call Bob Rosenberg 609-239-0358coverage, these services would be covered. We areVisit us atwww.anaboliclabs.com24 I Spring2019 www.anjc.info'