Medicare Questions

Question 1

Who can see a Medicare Patient?

Answer 1

Any provider that is registered with PECOS and has an NPI

-Both are required in order to bill a Medicare patient.

Question 2

What medicare parts will cover chiropractic visits?

Answer 2

Either Part B or Part C

(B = physician and other healthcare provider services, outpatient care, durable medical equipment and home health care)

(C = Medical advantage and offers Part A and B benefits, and may offer prescription drug coverage (part D), through private health plans)

Question 3

What is the 1st visit requirement for someone under medicare?

Answer 3

• Determine coverage eligibility
• Determine if active or maintenance care

Question 4

T/F Medicare will only reimburse maintenance care claims

Answer 4

FALSE

-Medicare only reimburses active care and NOT maintenance care

Question 5

What is needed to prove medical necessity?

Answer 5

Adequate documentation including OATs, patient history, treatment plan, etc.

Question 6

When can a non-PAR provider change to become a PAR provider (or vice-versa)?

Answer 6

During the open enrollment period as determined by the MAC

• Usually from mid-November through December 31st.
• Status change takes into effect the following January 1st.

Question 7

What eligibility must a person meet to qualify for medicare?

Answer 7

-›65 years of age or older

›-Disabled, any age received SS benefits for at least 2 years

-›People with end stage renal disease or ALS