Verifying QMBs Medicare Qualified Beneficiaries (QMB) hold special status when it comes to cost sharing in your office. It’s important to identify them carefully before any financial transactions have taken place. In 2017 CMS set up a system to help clinics and clearinghouses verify status. The system is called the HIPAA Eligibility Transaction System (HETS)….
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Medicare Modifiers FAQs Q: How do I bill Medicare for the statutorily excluded services such as exams, therapies and x-rays? A: When submitting Medicare claims for statutorily excluded services, each service must have a “GY” modifier. For therapy services, you must include the “GP” modifier as well (GY GP). The GP modifier is also referred to…
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Enrollment vs. Participation Participation in the Medicare program has nothing to do with Medicare enrollment. All chiropractors that treat Medicare patients must be enrolled in the Medicare program. Enrollment requires the completion of the CMS Form 855—the “Medicare Enrollment Application (See Fig. 1).” An annual open enrollment period held the last few months of the…
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Get started with your Medicare education by reviewing this brief, high-level training video on Medicare. Medicare coverage is quite different in Chiropractic than in allopathic medicine and here we cover the most important details of how Medicare works as a payer class in your practice. Then, study the visual of all four parts of the Medicare program.
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QMBs & ABN FAQ’s Q: What is a QMB? Why do I need to know if a Medicare beneficiary is a QMB before billing? A: The QMB (Qualified Medicare Beneficiary) program is a State Medicaid benefit that guides low-income Medicare beneficiaries through Medicare Part A and Part B premiums and cost-sharing (this includes deductibles, coinsurance,…
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Download Reference Document What could be more helpful than having a conversation guide at your fingertips when you need to discuss fees with a Medicare patient. CHUSA’s easy-to-read guide highlights points to discuss and even provides sample scripts for each situation to make it easier to hold these conversations yourself and/or to use to train…
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