Medicare Archives

Medicare’s Medical Necessity Reference Documents

Download Reference Documents Medicare publishes helpful documents and alerts to keep providers in the know about important topics. Included here are several documents that relate specifically to Chiropractic care and medical necessity. These tools relate to the proper use of the AT Modifier, Chiropractic documentation and the overall rulebook for Medicare policy, The Benefit Policy…

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FAQ-Medicare Active vs. Maintenance Care

Active vs. Maintenance Care FAQs Q: If a Medicare patient moves from Medical Necessity treatment to Wellness and we have him/her sign an ABN, are we required to continue to bill Medicare with the appropriate modifier or can we convert the patient to cash? A: The ABN offers three options at the bottom of the…

The Relationship Between Box 14 and Medical Necessity

A provider of service communicates important information about a patient’s episode of care by placing important information in Box 14 of the 1500 billing form. The date that is placed in this important field on the billing form communicates the first date of the current episode of care. This brief training will outline it’s importance…

Proper Patient Case Management

The Case Management Picture Case management has its roots in the patient’s clinical presentation and the doctor’s training and expertise. Doctors have a fiduciary responsibility to evaluate patients and determine the whole clinical picture to the best of their ability. The patient evaluation process is quite linear. The doctor begins by gathering the patient’s history…

Medicare Decision Making Matrix

Download Support Tool This tool is one of the most useful and important tools in the KMC University Curriculum. Although designed for Medicare using Medicare terminology, the flowcharts apply to any type of third-party insured patient. An important question is posed as a patient presents to the office: “Is this patient currently in an active…

Active vs. Maintenance in Medicare

Recognize the Differences Between Active and Maintenance Care One of the most difficult concepts for providers to grasp is the fine line that exists between the necessity of active treatment and when the care would be deemed maintenance. This distinction is critically important because declaring a visit to be medically necessary, therefore billable to and…