As a service to our members having difficulties billing Medicare claims, we are providing a link to the official Medicare Billing Instructions and an annotated version that includes tips learned from members sharing their experiences.  Examples of new information and lessons learned include:

Medicaid providers are currently being required to re-enroll, including submitting fingerprints if they have not been updated with your licensing board within the last year. Additionally the Providers’ General Handbook, Chiropractic Services Handbook and Fee Schedules have been updated.

Some of our members have received a Comparative Billing Report (CBR) from Medicare and others can access their own statistics upon request.  In order to understand the significance of the statistics, an online webinar is available that explains what the numbers reflect.  Requesting a CBR is not connected with and does not precipitate a probe, audit or other adverse action by Medicare.  It is a tool to help chiropractors self evaluate their billing activities as it compares to all Florida chiropractors and all chiropractors nationwide within Medicare.

(From ACA “Week in Review” of 04/11/2013)  In addition to the results from a May 2009 Office of Inspector General report covering inappropriate Medicare payment for chiropractic services, Palmetto GBA/Railroad Medicare has identified chiropractic services as "vulnerable" due to the high percentage of errors discovered during the post-payment review process. To resolve this vulnerability, Railroad Medicare has changed the process for reviewing claims submitted with CPT codes 98940 and 9894--along with HCPCS modifier AT. The contractor is currently requesting documentation for claims submitted with these codes. This review will be performed on a pre-payment basis.