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Hey, hello everyone. This is Sam Collins, your coding and billing expert for HJ Ross, and of course ChiroSecure. Hi. Thanks for spending some time with me. Let’s clear up some of the controversy, or I won’t say controversy, confusion when it comes to coding and billing. In fact, what I’d like to do is try to.
Probably uncomplicate what many tried to make complicated, I think, and often to get you to buy what they have or to explain it in a way that only you could be helped by them and so forth. And you know what I’m talking about with some of the people always trying to sell you something, get something from you.
Our services there to help you get paid more. By making things simpler, and that’s what we’re gonna talk about today, what’s going on, and what started, of course, this month we’re in July. July 1st is there’s an update to the Medicare Advanced Beneficiary Notice or abm. Let’s go to the slides. Let’s take a look at what’s going on.
Well, this revision occurred July 1st, which means as of now, when a patient comes in the next time and they’re on an abn, make sure they sign a new one, or any person that is. Going to be on. One has to use the new form. It’s a brand new form. Now, you’ll notice the form is gonna be very, very similar, but there are differences and there’s a revision date that you do have to be made aware of to make sure it’s compliant.
It’s nothing to overly front about because an ABN form is not that complicated. What is an abn? Really? We make this, it’s an advanced beneficiary notice, or we say ab n. And it’s meant for making sure that services that Medicare will be expected to pay for or not pay for the patient is made aware, in other words.
That the patient is made aware before the visit what they’re gonna have to pay for. Now for chiropractic, technically this applies to the manipulation, but it can be more. So the bottom line is it’s a way of listing the services that’s gonna be provided and what is not gonna be covered, so the patient is fully aware of what their costs are gonna be.
In other words, I think in many ways what you wanna think of is just keeping it simple. Chiropractic services to Medicare is straightforward. This form is to tell me what services Medicare. Is going to cover, but then not cover. So chiropractic covers spinal manipulation only for Medicare. So we all have known that since Medicare started in the late sixties, early seventies, they cover only spinal manipulation, which means of course, these three codes, just the spine ones.
That means everything else. And this is how simple it’s, you want to explain to a patient what Medicare doesn’t cover. They cover spinal manipulation. That’s three codes. There are approximately 2000 C P T codes, which means the other 1,997 codes are not covered. So real simply, if it’s not spider manipulation, it’s not covered by Medicare, so the patient’s gonna be made aware that’s not covered.
Now I suggest just at the beginning of care, make sure a patient’s aware of that your coverage for Medicare is limited to spinal manipulation. And everything else we might do, whether it’s exam or therapy or whatever it is, is going to be out of pocket. There’s no other person that’s gonna pay it unless maybe you have a true secondary.
In fact, if you really think of it, what is this? And ABN is the original no surprise form. We all know we made aware last year. You have to make sure patients are aware of what their costs are gonna be. Well, hasn’t chiropractic always done that? Of course we have, I think chiropractors are probably the best at it to make sure people know what they’re paying out of pocket.
Cuz we’re used to people paying out of pocket. Many of you’re gonna do cash, but remember for Medicare, you can’t do cash for Medicare. You have to be registered and be able to bill. Hence why we have to know all this information. So this is assuring that a Medicare base is made. Aware before or in advance what they’re gonna pay out of pocket.
So this new form was updated on July 1st. Now it’s been out for a little while. If you’re a network member with me, you’ve gotten a notice from me. They’re all online and are digital coding there for you. But the new form you look at and go, well, gosh, it’s pretty much the same. It really is. Except for, I’ll go back.
This is the old form now. If you look at the new form, You’ll say, well, that all looks the same. The old form, you’ll notice some differences. The biggest difference, frankly, at the very bottom notice, the revision date was 2023. The new revision date, of course, is 2026. The form itself is pretty much similar, all at the top.
There are some changes at the bottom, so you can’t use the old one. The simple truth is don’t make this confusing. If you have a patient on a current A D N. It’s for manipulation. Have them sign a new one on their next visit and then continue it just the same way. All this form is to do is to make a patient aware of what is not covered.
Let’s not overcomplicate it. It’s really simple. You’re gonna put the patient’s information and yours at the top and list what is or isn’t going to be paid for. So in this case, because you’re mostly gonna do it for manipulation, you would list spinal manipulation. The reason Medicare’s not gonna pay for it and the price.
Simple as that. Nothing complicated. It could be handwritten or you can type into the form whichever way you want it, but it’s pretty straightforward. It’s just to tell the patient what is not covered, and then the patient has options. The options are I want the service, but Bill Medicare, even though if it’s not covered, it’s not gonna be paid, but at least that way they get an EOB or option two, which I think many of us prefer.
If a patient chooses option two, it says, I want the services, but do not bill Medicare. So when you have a person on maintenance for manipulation and they go, Hey, doc. I’m just gonna pick option two cause I know Medicare’s not gonna pay. Why are we gonna go through the whole hassle that makes it easier for you than in many ways it is kind of like a cash patient.
You don’t have to bill Medicare now. We can’t force the patient to pick one or the other. I would explain it’s obviously a lot simpler if they pick option two because we’re explaining to the patient, Medicare’s not gonna pay for this. You can have us bill for it. They’re not gonna pay, which means I’m gonna do the work to do the billing.
Medicare has to do all that work and then send you a notice to say, we’re not gonna pay, which you already know. So many times they’ll go, well, why go through that hassle? That’s a lot of bureaucratic, you know, uh, red tape. Let’s just pick option two. Now, if they don’t wanna pick it, fine, no big deal, bill.
It’s automatically denied. Or they also have an option three, and this is an important thing to remember. We’re not forcing a patient to get care. It says here, I don’t want the services. Well, if they don’t want the services, that’s fine. That just means, okay, good. I’m not gonna come in, I, I can’t continue to pay for my therapy, or excuse me, in this case, the therapy, I mean for chiropractic, meaning manipulation.
So, simply put, this is a way of making a patient aware of when manipulation is not gonna be covered. They’re responsible. They can choose to get the care or not get the care. And in getting the care, there’s two ways we go about it. Option two, I prefer. But if they choose option one, no big deal. Of course, option three just simply means if they pick option three, so be it.
We still have to build a Medicare bottom line is it’s a notice to inform that a service that is normally covered will not be covered. And I think this is where people are confused. A lot of times offices will use a blanket form at the beginning like this to explain to the Medicare patient all the things that aren’t covered.
I mean, they’ll just list everything, exams and therapies and so forth, which I think is fine. I think it’s reasonable cuz that way you’re giving the patient as much knowledge as possible about what is and isn’t covered. But what it’s really intended for, for chiropractic purposes is to inform them when manipulation is not gonna be covered.
So it’s a service that’s normally covered like spine manipulation, but it’s not gonna be covered and it’s not covered. Why maintenance, Medicare doesn’t pay for that many visits. Medicare doesn’t pay for that diagnosis and so forth. So any of those non-covered conditions or diagnosis and or just long-term care.
The idea of using it though for beyond that, you can, if you are using it to inform about all excluded services, you can. I’ll show you an example, but can you inform the patient at the beginning what Medicare does and doesn’t pay for? If you’ve been to our seminar, if you’ve been to our network, you know I have a separate form for that.
That’s hopefully a lot simpler. It just explains Medicare at the beginning, kind of a financial agreement. Medicare only covers manipulation. Any and all other services you may get, such as exams and x-rays and therapies are out of pocket. That way it makes it clear there’s gonna be no misgivings that the patients say, I thought everything was covered.
Cuz you all well know when a Medicare patient comes in, they’re new to Medicare, they think, I thought everything was covered. We gotta whoa, slow down. It’s not everything. But it is gonna cover the spine manipulation. Other services you are getting would not be covered, so that’s fine to do that. But if it’s for maintenance of A C M T, that’s something you wanna make sure that you do separately.
You don’t want to have a blanket. You can use a blanket one at the beginning kind of for everything, but it’s not gonna work for the maintenance care for manipulation, cuz it has to begin when manipulation is maintenance. So be careful and this is the mistake I often see. You list manipulation way, way back, and then later try to say, oh, I have a valid uh, abn.
You don’t, it has to be on the visit where it’s not gonna be covered. So unless it’s the very first visit, You can’t have a blanket one for obviously manipulation. You can if you wanna include other services. Now, a lot of people ask, well, do I have to have them sign this every time? For those that are old enough, remember when Medicare patients had to sign that form and every time they came in, they had to sign it?
Oh my God. That’s been gone really since the late eighties. But nonetheless, you don’t have to have them sign at each visit. You have them sign at once, but you wanna make sure that it is something that’s signed with the understanding. It’s gonna be for a series of visits or an amount of time for spinal manipulation.
Specifically though, it’s gotta be signed on the visit where care begins to be maintenance. So you can’t sign one three months ago and say, okay, it’s maintenance now. If it’s maintenance, now you have to do a new form for the manipulation. My suggestion, if you wanna make a blanket ABN for everything, I think that’s fine.
Just understand when it’s time for manipulation to be maintenance, that’s gonna be a brand new one. Now, here’s the good news. Once they sign one, let’s say you’re going, Hey, patient says, doc, this feels so good. I want to come once a week every two weeks to stay tuned up. I think that’s a good thing.
However, Medicare’s not gonna cover that. So we explain to the patient not covered. They say, I don’t care. I know it makes me feel good. Great. They sign an abn and I would actually indicate twice per week for the next year. An ABN actually can extend for an entire year before you have to sign a new one, so long as that’s indicated on the form.
So you can put a timeframe. You can put a number of visits, but not to exceed one year. So here’s an example of someone that said to me that just kind of does a blanket one notice. They say exams, X-rays, manual therapies. Again, all therapies aren’t covered with a price estimate here. The one thing I wouldn’t agree with though is the maintenance care, because it’s not defined well, maintenance care, meaning what?
You’ve gotta obviously put the C M T. Now, again, I’ll still say this is okay at the beginning of care. But you have to have a separate one when it’s time for manipulation to show it’s not covered, but pretty straightforward. It’s easy to fill in. By the way, there’s a fill in the blank type. I’ll give you some links to that later.
Here’s what you need to do when it’s manipulation. Notice what we have here. It just says spinal manipulation. I would, in fact, probably put the code 98 9 4 0 4 1, whatever you might think it will be, and then it’s any one of these three. I’m not saying list all three, but I’m saying just make it simple.
Medicare does not cover maintenance care. That’s easy. Or Medicare does not cover this many visits for your diagnosis. Maybe they got a low level diagnosis of pain, obviously see after maybe 20 visits, we’re not gonna further that one. Or how about this? Medicare will not cover. You know what this is meant to do.
Tell the patient it’s not covered. Now, once they’ve done this, this is when you bill with a modifier GA that informs Medicare. This notice is signed. That patient becomes responsible. If you don’t have this on file and Bill with the GA and Medicare denies your care is not medically necessary and you appeal and let’s say you lose that appeal, you can’t be paid for it.
You can’t go after the patient cuz you didn’t inform them before they would be. Required to pay. So in other words, you have to really make sure you know the care is medically necessary and that if you feel you have to defend it, you can. That’s why I’d say don’t be afraid to look at your Medicare diagnosis list to know what is short term, moderate, and long term to know where your visits are fitting.
Net members with me, make sure you’ve gotten that list. If you’ve attended our seminar, you certainly haven’t, but know which diagnosis equals what number of visits, cuz that’s often where people run into trouble. I would certainly say. Probably for many patients it would be easy to think easily, 12 visits to 25 visits a year, sometimes more depending on the condition.
But when it becomes maintenance, this is required. Now, I didn’t put the estimated cost here cause I just wanted to show this as an example, but I want to focus in on the options. Options one, two, and three. Yes, I want the care, but Bill Medicare now if you bill Medicare, when you sign this A B N, we know they’re not gonna pay.
That’s how we inform Medicare with the ga. The good news is I would inform a patient once they’ve signed this, I want it to be clear to them once we’ve hit this point, Medicare is not paying period. There’s no like, maybe they will, they’re not. So therefore they might choose to and say, well, why go to the BOTHER billing?
Just let one pay for the care. And of course, option three, cuz no one should be forced. Okay? I don’t want the care. And then of course, the patient signs at the bottom. You maintain a copy. Make sure to give them a copy. Truthfully, many patients will go, I don’t want one, but you want to at least offer it.
Now, people ask about the cost. This is something that’s sure, that’s gonna surprise many of you, but this is why you always wanna have a Medicare expert with you. Under the Medicare claims processing manual, specifically section 50.9, it says this, A beneficiary meeting. The patient who has been given a properly delivered a B N and agrees to pay may be held liable.
Well, of course, that’s the whole point of it, but notice the underlying part. The charge may be the healthcare provider or suppliers. Usual and customary fee and is not limited to the Medicare fee. So if a patient is on maintenance care, could you actually charge them your regular fee if you choose to?
Absolutely. You may. Medicare does not control the fee unless they’re paying for it. So if it’s maintenance care and you’d like to, you can charge more. So I know people in welfare areas sometimes do that. Some of you may say, no, I don’t want you. I’m gonna charge Medicare rate. Here’s what I’m pointing out.
That’s up to you. So therefore you have some solidarity in that once it becomes maintenance care. But again, we have to remember the patient’s gonna say, well, when you billed Medicare before it was $35, but now that I’m paying your regular rate, it’s 55. Yes. Cuz you’re paying like everyone else. Again, you just have to be the right area and the right office to do that.
Bottom line is that’s what you wanna do. Inform the patient what is, it isn’t covered what they’re gonna pay, and you don’t have to have ’em sign it every single time. Now, there’s something unique about this I wanna highlight because I know many of you’re aware that there’s a par and a non-par provider if you’re a non-par provider.
The ones I’ve showed you before, that’s not the one for you. There’s a slight difference to non-par. Now, many of you probably aren’t aware of this because you probably didn’t read the full instructions, which are some 30 pages long. But bottom line is there’s some things you have to add additionally. So on this form I’m gonna point out there’s some additional things that are written in for a non-par provider.
You’ll notice for a non-par provider, they strike out the last sentence of option one, and then it additionally says here, Additional information. The supplier doesn’t accept payment from Medicare for the items or services listed on the table above. If I check option one above, I am responsible for paying the supplier’s charge at items at to the supplier and does not, and the Medicare will not pay.
Yours gonna pay you. In other words, what they’re telling them is. You don’t have to wait for a decision. You have to pay up front. In other words, that’s what non-par means. A non-par provider, you don’t have to accept assignments. So this is just additional information that they’re paying the provider directly.
There’s no misgivings. In other words, we’re really clear. I don’t want anyone upset at you, cuz there’s nothing more frustrating than a person thinking something’s covered and then we don’t explain it properly and it’s later not covered. And then they blame us. Make it real clear. What’s an ABN for?
Making sure a patient AW is aware when maintenance visits occur for manipulation, it’s not covered. And they agree to have the service or not. If you would like to use it to blanket everything at the beginning, I do think that’s fine, but at the same token, you can’t put those all together on one. So realize the maintenance visit for manipulation can’t be the initial time with everything else unless the first visit is maintenance, which is doubtful.
So save the one for manipulation when it truly becomes maintenance. Don’t make this overcomplicated. It is simply put to make sure a patient’s aware of what their charges are. Now here’s the good news. Medicare is pretty viable. There’s a lot of Medicare patients. In fact, there’s 10,000 new Medicare patients every day Baby Boomers attorney that I, I’m part of that group.
I’ll be on Medicare in two years. Bottom line is start to make sure that you got a clear understanding to make sure your patients understand. And don’t make it hard. Don’t feel like, oh my God, I feel trapped. I don’t know. This form is available on the CMS website. If you just did a search for the new, um, advanced beneficiary notice there’s versions in English.
Spanish, there’s actually large print in both languages, and it comes in a pdf, which means you print and hand write it, but there’s also a Microsoft Word version, which works in any of the other ones, like pages and all that, and you can type into it and then print out what you like. Now, if you’re a network member with me though, however, the one thing that the CMS doesn’t do, they don’t give you how to make it the non-par amount.
So you have to read the instructions for that. So I implore those of you who aren’t part of the network to do that. But if you’re a network member, just contact me or go directly to our site. They’re right there. That’s what we always wanna be here to do. Make sure things are simple. That’s what ChiroSecure does these programs for.
Try to uncomplicate what people try to make complicated the network. What I run means that I become part of your staff. Call me, email me, zoom with me. We fix all your problems, help you make more money. I’m gonna say thank you to everyone. Don’t be making overcomplicated with Medicare. It’s easy. I’ll see you next time everybody.