Understanding Medicare Fees as a Chiropractor
(for Providers that are Participating or Non-Participating, Accepting Assignment or Not)

Updated: April 4, 2011
Dear Doctors and Staff,

I know you are very busy.... but please read and understand the importance of this message! It may save you "big bucks"!
We do have a dual fee schedule in our Chiropractic offices. They are our normal customary fees and the fees set for you in your state local by your Medicare Carriers. DO NOT MIX THEM UP!
As a participating provider, even though your Medicare Carrier has a set fee for you, you may bill your Medicare Carrier for a payable service (98940, 98941 and 98942) whatever fee you wish. Your Medicare Carrier has the responsibility to reimburse back to you 80% of the Medicare fee only. Not the amount you billed. You must collect from the patient the other 20%, either from the patient or supplemental insurance, not one penny above the Medicare fee set by your Medicare Carrier.
As a non-participating provider, marking the box you accept assignment (money sent to the doctor), you can NOT bill the Medicare Carrier above the non-par fee set for you by your Medicare Carrier. You also must collect the 20% from your patient or supplemental insurance. You can never receive payment from Medicare or your patient above the non-par fees set for you by your Medicare Carrier.
As a non-participating provider, NOT accepting assignment (running business like it should be run.....patient comes in, gets a great Chiropractic adjustment, goes to the front desk and pays for everything), you can collect from your patient, at time of visit, for the adjustment the "limiting charge" (113% higher than participating provider fees). You bill Medicare the "limiting charge" and the Medicare Carrier pays, to your patient, 80% of the non-par fee and their supplemental insurance pays 20% to your patient.
If either participating or non-participating providers collects money from anyone above the set fees of your Medicare Carrier, the fines begin at $10,000.00 per incident. If a non-participating provider bills the Medicare Carrier or any payer (PI, WC) on a Medicare patient above the limiting fees set by your Medicare Carrier on a Medicare patient, the fines begin at $10,000.00 per incident.
BOTTOM LINE: If you wish to learn how to do Chiropractic Medicare correctly, including "documenting" by federal standards, please consider ordering our Chiropractic Medicare DVD and booklet. It explains piece by piece every important step in doing and billing Chiropractic Medicare so there are no limits for the chiropractic adjustment. If you are audited you will have done Medicare correctly and win your audit. You and your staff will be very happy you have this important and mandatory information. I promise it will make a difference in your understanding of Medicare and how you bill Medicare.
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Keep in mind, Medicare is the only insurance type program that if done incorrectly is fraud, a felony, a fine and/or jail.

I promise you will be more than satisfied that you made the right decision to purchase this information or attend our presentation. Please give me a call if you have questions. 1-618-395-3162

Best regards,
Dr. Gary R. Street

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