What is Medicare? Who runs the Medicare program? What is Medicare Part A? What is Medicare Part B? What is Medicare Part C? Are patients automatically enrolled in Medicare Parts A, B and C when they turn 65? How do we know if a person is eligible to receive Medicare benefits? My patient has enrolled in a Medicare+Choice plan for which I am not a provider. Who is responsible for paying for my services? Can I enroll in Medicare before I receive my chiropractic license? Do I have to wait until I received my Medicare number before I can provide services to Medicare patients? What does the word “participating” mean in the context of the Medicare program? What does “accepting assignment” in Medicare mean? Are Medicare providers allowed to waive Medicare Coinsurance? What is a “non-participating” provider in Medicare? Does a participating provider have the option to accept assignment on certain claims? Can I change my mind after I have chosen my participation status with Medicare? How are Medicare reimbursement rates calculated? What does “limiting charge” mean? May we round the limiting charge? Does Medicare’s limiting charge apply to my exams, x-rays, modalities, or supplies? We are a nonparticipating provider. Must we always check the “no” box in Box 27? May we submit handwritten CMS 1500 claim forms to Medicare? What are the most common reasons why Medicare rejects a claim? Are Medicare providers allowed to waive Medicare deductibles? What is EFT? What are the advantages of EFT? When is Medicare considered secondary? What are Medicare deductibles based on? Who is allowed to appeal the denial of an assigned claim? Who is allowed to appeal the denial of a nonassigned claim? What types of hearings are available? We appealed a claim denial and lost. What are our options? How do we file a request for a Medicare hearing? What is the deadline for filing a request for a hearing? If we lose the decision at a Medicare hearing, do we have any other options? Can Medicare charge us interest if we do not refund overpayments within 30 days? Does a supplemental carrier have to pay chiropractic claims in full? Should we refund Medicare immediately if they overpaid a claim? Can you provide a sample letter for supplemental carriers that reject our claims? Is the Office of Inspector General’s compliance program the best to use? How are post-payment reviews conducted? When are chiropractors notified about changes in Medicare’s fee schedule? Can I be punished with jail or fines for making innocent mistakes? Does Medicare review claims differently for participating vs. non-participating providers? What is Medicare’s Integrity Program (MIP)? Does Congress require Medicare to reach some kind of quota for refunds? Are providers that make honest mistakes penalized by Medicare? What portion of Medicare Integrity Program funds are used for claim and medical necessity review? How are providers selected for medical necessity reviews? What percentage of Medicare Integrity Program Funds is spent on anti-fraud activities? Why can’t Medicare implement a “one-strike” policy, so that first time errors are dealt with through education? How does CMS make sure providers have input into Medicare rules and program decision? What are the benefits of implementing a Medicare compliance program? Does Medicare look for anything special for its compliance policies and procedures? What billing violations does Medicare perceive as the biggest risk to a chiropractor? How can a chiropractor minimize “not medically necessary” determinations? What concerns does WPS-Medicare have with the way CMS 1500 forms are prepared? Can I pay my billing service based on a percentage of the revenue they bill? May a chiropractor routinely waive a Medicare patient’s deductible? May a chiropractor ever receive anything of value in exchange for giving another provider a referral? May a chiropractor ever pay anyone in exchange for a patient referral? What should be the specific job responsibilities for the person in charge of the compliance program? How quickly should a new employee be given Medicare compliance training? What are the seven basic elements of a Medicare Compliance Program? Why are staff meetings more effective for solving compliance problems than a memo posted on a bulletin board? Does Medicare expect me to discipline staff members when they make a mistake following Medicare’s procedures? What disciplinary steps are a “best practice” for a Medicare compliance program? How does Medicare define “maintenance care”? Am I responsible for my billing service’s failure to follow Medicare’s rules? Can my billing service receive my checks for me? What is the penalty for a non-participating provider who bills in excess of Medicare’s limiting charge? May I advertise that I provide Medicare or Medicaid services? What is the best internal audit tool I can use to let me know when I might have a problem with Medicare? What is the penalty for chiropractors that bill for adjustments that were never performed? How does Medicare define “subluxation”? Does Medicare require the subluxation to be documented and, if so, how? What should I do when I learn Medicare has overpaid me? Should a chiropractor’s technique influence their choice of CMT code? What are Medicare’s documentation requirements for the patient’s first visit? What are the attributes for a person running our compliance program? Is Medicare serious when they threaten penalties? What are Medicare’s documentation requirements after the initial visit? What are the categories of conditions that Medicare recognizes for coverage? What appeal options are available when Medicare denies a claim? What are Medicare’s guidelines for establishing the “medical necessity” of chiropractic care? What is the purpose of the ABN? Is the diagnosis of “pain” sufficient to establish the medical necessity of care? How do blind patients sign ABN forms? What if we do not have our patients sign ABNs? Is Medicare a managed care program and who writes its rules? We moved our office and our Medicare checks stopped coming. Why? How long do we have to file Medicare claims? If national health care becomes a reality, will participating Medicare provider have an advantage? Will a participating Medicare provider have an advantage under a national health plan? I am constantly frustrated in my attempts to discuss problems with Medicare. Am I alone? Must we have our patients sign an “Advance Beneficiary Notice (ABN)? May we have the patient sign the ABN after they have received treatment? Does the ABN requirement affect both participating and non-participating chiropractors? Must patients be given copies of each ABN form they sign? What are Medicare’s treatment guidelines? Since Medicare patients must be given a copy of each form they sign, can we have the ABN printed on 2-part paper? Can we print the ABN form on 2-part paper and give the patient a copy? Must we list every service we provide on the ABN form? Can we create our own “Advanced Beneficiary Notice”? Will using the ABN form be a violation of the HIPAA laws? Many of our patients are visually impaired. May we expand the ABN form so that it is legal sized? May we expand the ABN to assist our visually impaired patients? What do I do when a patient refuses to sign the ABN form? What is the proper way to fill out the ABN form for patients receiving maintenance, wellness, or preventative care? What is the proper way to fill out the ABN form for patients receiving maintenance care?
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