Overview Flashcards
AT
medicare modifyer
acute, active, restorative, arrest of progression, corrective care
GA
medicare modifier
maitentenance, ABN signed, patient know medicare won’t pay, can collect from patient
GZ
medicare modifier
you forgot to present the ABN to the patient, ABN was not signed, cannot collect from patient, medicare won’t pay
GY
medicare modifiers
statutorily exluded service
patient knowns medicare won’t pay, can collect from patient
GX
medicare modifier
statutorily excluded service
ABN voluntarily signed
can collect from patient
premium
amount patient has to pay per month
co-pay
set dollar amount due the day the patient is seen
co-insurance
% patient is responsible for
deductible
set dollar amount patient has to pay before insurance will kick in
explanation of benefits/remittance advice
provider calls insurance company to see what the insurance covered
verification
docor explains the benefits patient can receive
CMS
center for medicare and medicaid services
OIG
office of inspector general
looks for fraud
NPI
provider number
need one to enroll in medicare
MAC
medicare administrative center
day to day claim processing
medical necessity
validates the reason we saw and are treating the patient
enrollment in medicare
gone through online process
have NPI
can be PAR or non-PAR
treatment plan
frequency of visits
next date for evaluation
prognosis
duration of treatment plan
HCPCS
deals with medical equipment and supplies
ICD-10 CM
diagnosis codes for patients
CPT/CMT
adjusting codes
who can see medicare patients
people who have NPI
what part of medicare covers chiropractic care?
part B and C
what is needed to prove medical necessity?
documentation has to line up with diagnosis codes and procedure and linked with pointer
how can you be eligible for medicare
65 or older
renal failure
ALS
what services will medicare pay for?
adjustments only
what order should you diagnose for medicare patietns?
- subluxation (M99…)
2. diagnosis
how old can a date of onset be before medicare considers it maitenance?
31 days
where do the OIG find problems in records of chiropractors?
treatment plan
validating medical necessity
date of onset isn’t the same day they saw the patient
what is re-validation? how often?
every 3-5 years
verifying and validating enrollment with medicare
