Medicare Archives

Medicare Crosswalk Rules

The Crosswalk Between Medicare & Other Plans The great thing about patients having an insurance plan in addition to Medicare is that very often the claim is forwarded to the secondary carrier automatically once the Medicare carrier completes its claims process. Medicare calls this a “crosswalk feature.” You can assist your patients with this feature…

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Billing For Family Members

Medicare Rules for Billing Immediate Family Members Medicare is very specific about how immediate family members should or should not be billed. Become familiar with the specifics of these scenarios to ensure you comply. According to the Medicare Benefit Policy Manual, Section 130 specifically states that any expenses resulting from charges made to immediate relatives…

Medicare Timely Filing Guidelines

How Much Time Do You Have? We are often asked how much time an office has to file claims to Medicare. This is of particular interest when Medicare is a secondary payer, and the office must wait for the primary carrier to pay or deny before billing. Medicare Timely Filing is addressed in Section 6404…

Proper Use of the 1500 Claim Form

Guidelines for Using the 1500 Claim Form The 1500 billing form is the connection from the practice to a payer, and in this case the Medicare Administrative Contractor (MAC). Whether you are billing on paper or electronically, each field should be completed exactly according to the guidelines to ensure proper claims payment. These two helpful…

Medicare & Chiropractic- A Unique Relationship

If you struggle with when to bill Medicare and when the patient is responsible for treatment, this mini-class can help you sort it all out. When you are clear on the differences that make Medicare billing unique (e.g., the three covered codes for spinal manipulation, the appropriate use of the ABN form, and the nuances…

Medicare Claims – Paper vs Electronic

What are the Rules? Since October 16, 2003, The Administrative Simplification Compliance Act (ASCA) prohibits payment of initial health care claims not sent electronically, except in limited situations. The exclusion that applies to most doctors of chiropractic is the ‘small provider claims.’ CMS states: The word “provider” is being used generically here to refer to…