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Medicare Charge and Fee Rules

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Medicare Curriculum | Section 3
Medicare Charge & Fee Rules
Medicare Charge and Fee Rules

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Medicare Basics

How Medicare Works

12 Resources | 1 Quiz

What Is Medicare?
Medicare Hierarchy
Brief History of Medicare and Chiropractic
Different Types of Medicare Coverage
What is Part B Medicare?
What is Medicare Advantage?
Replacement Plans in Medicare
Alternative Medicare Plans-Railroad and United Mine Workers
Secondary and Supplemental Medicare Coverage
Participating vs. Non-Participating Provider Status
Medicare Participation and Non-Participation
Medicare Basics Reference Documents
How Medicare Works

Working with Your Medicare Administrative Contractor (MAC)

6 Resources | 1 Quiz

Your Medicare Administrative Contractor’s Job
Your Medicare Administrative Contractor (MAC)
Interacting With Your MAC
Medicare Learning Network
Medicare Coverage Documents
Medicare Quick Web References
Working with MAC

Mandatory Medicare Enrollment

10 Resources | 1 Quiz

Mandatory Medicare Enrollment for Chiropractors
Opting Out is Not an Option
FAQ-Medicare Provider Opt-Out
FAQ-Medicare Enrollment
Par VS Non-Par Comparison
EDI Enrollment vs Paper Claims
I Submitted My Enrollment-Now What?
Help! I’ve Fallen Out of Medicare
Maintain Active Enrollment
Medicare Enrollment Tips and Tools
Mandatory Medicare Enrollment

Medicare in Your Chiropractic Office

4 Resources | 1 Quiz

How Medicare Works with Chiropractic
Medicare and Limitations of Chiropractic Coverage
How Medicare is Different with Chiropractic
Chiropractic Specific Medicare Guidance from CMS
Medicare in Your Chiropractic Office

The Qualified Medicare Beneficiary

6 Resources | 1 Quiz

What is a QMB?
QMB Compliance
How to Verify QMB Status
Billing QMB Patients
FAQ-Billing QMBs
Qualified Medicare Beneficiaries (QMB) Reference Documents
Qualified Medicare Beneficiaries (QMB)

Medicare Basics Final Course Assessment

0 Resource | 1 Quiz

Medicare Basics Final Course Assessment

Medicare Advance Beneficiary Notice (ABN)

An Overview of the Advance Beneficiary Notice (ABN)

8 Resources | 1 Quiz

The ABN-Mandatory vs. Voluntary
What is the ABN of Non-Coverage?
The Role of the ABN Notifier
Medicare Chiropractic Services- Covered vs. Non-Covered
Medicare Coverage Limitations
FAQ-Medicare ABN
Advance Beneficiary Notice (ABN) Facts
Medicare Advance Written Notice Resources
The Advance Beneficiary Notice (ABN)

The Mandatory Advance Beneficiary Notice (ABN) Form

7 Resources | 1 Quiz

Issuing a Mandatory ABN
Mandatory ABN Common Errors
The ABN Process
A Guide to Medicare Modifiers
Medicare ABN Templates
FAQ-What You Need to Know About QMBs & ABNs
Advance Beneficiary Notice (ABN) Reference Documents
Mandatory ABN for Spinal Adjustments

Voluntary ABN for Excluded Services

6 Resources | 1 Quiz

The Voluntary Advance Notice ABN Form
Is it Mandatory or Voluntary?
Statutorily Excluded Services
Voluntary ABN Resources & Templates
Medicare Modifiers & ABN Implementation
Advance Beneficiary Notice (ABN) Reference Documents
Voluntary ABN for Excluded Services

ABN Final Course Assessment

0 Resource | 1 Quiz

ABN Final Course Assessment

Medical Necessity & Documentation in Medicare

Start with PART

8 Resources | 1 Quiz

A Brief Overview of PART
PART Documentation for Medicare
Don’t Forget to do Your PART for Medicare
Primary vs. Compensatory Subluxations
Documenting PART
Documenting PART in an Initial Visit Note
Using PART as Part of your ROV Documentation
Medicare Benefit Policy Manual – Section 240, Chapter 15
Start with PART

Proving Medical Necessity

10 Resources | 1 Quiz

Medicare’s Definition of Medical Necessity
What is Medical Necessity?
Medicare’s Definition of Medical Necessity
Medical Necessity vs. Clinical Appropriateness
Active vs. Maintenance in Medicare
Medicare Decision Making Matrix
Proper Patient Case Management
The Relationship Between Box 14 and Medical Necessity
FAQ-Medicare Active vs. Maintenance Care
Medicare’s Medical Necessity Reference Documents
Proving Medical Necessity

Medicare Documentation Requirements

8 Resources | 1 Quiz

Medicare’s Documentation Requirements for Medical Necessity
Medicare Documentation Requirements Explained
Medicare’s Definition of Medical Necessity
Medicare Diagnosis Rules
Incident, Burst, or Episode
Use of OATS to Create Effective Short Term Goals
Be the GOAT of the OATs
Medicare’s Documentation Reference Documents
Medicare Documentation Requirements

If it Isn’t Signed, It Didn’t Happen

6 Resources | 1 Quiz

Understanding Signature and Authentication Requirements
Signature Requirement Errors
FAQ-Medicare Signature Guidelines
Signature Self-Audit Tool
Signature Verification Form
Medicare Reference Documents-Signature Guidelines
If it Isn’t Signed, it Didn’t Happen!

Medical Necessity & Documentation in Medicare Final Course Assessment

0 Resource | 1 Quiz

Medical Necessity & Documentation in Medicare Final Course Assessment

Verifying the Type of Medicare Plan

Medicare Verification of Benefits

3 Resources | 1 Quiz

An Overview of Medicare Verification
FAQ-Medicare Verification
Verification of Benefits Resource Documents
Medicare Verification of Benefits

How to Avoid Medicare Part C Pitfalls

3 Resources | 1 Quiz

Part C Pitfalls
Medicare Advantage Part C Compliance
Part C Pitfalls Reference Documents
How to Avoid Medicare Part C Pitfalls

Verifying the Type of Medicare Plan Final Course Assessment

0 Resource | 1 Quiz

Verifying the Type of Medicare Plan

Medicare Coding & Billing

Medicare Charge & Fee Rules

7 Resources | 1 Quiz

Participation Status Determines Medicare Fee Schedule
Medicare Charge and Fee Rules
Review of Medicare Fee Schedule for Participating Providers
Review of Medicare Fee Schedule for Non-Participating Providers
Fee Schedule Comparison for Medicare Par vs. Non-Par Providers
Additional rules and options for statutorily non-covered services
Excluded Services
Medicare Charge & Fee Rules

Medicare Modifier Mastery

4 Resources | 1 Quiz

Medicare Modifiers to Bill for CMT
Commonly Used Modifiers for Chiropractic Medicare Coding
Medicare Modifiers for Excluded Services
Important Modifier Factoids
Medicare Modifier Mastery

Charging for Medicare Maintenance

3 Resources | 1 Quiz

How to Charge for Non-Medically Necessary- Wellness/Supportive or Maintenance Care
Collecting for Non-Covered Maintenance Care
Three Payment Options for Medicare Maintenance Care
Charging for Medicare Maintenance

Medicare Coding & Billing Final Course Assessment

0 Resource | 1 Quiz

Medicare Coding & Billing

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