SGR Repeal Legislation
The House Ways and Means and Senate Finance Committees have released a draft legislative proposal to eliminate the Medicare Sustainable Growth Rate (SGR) formula. The proposal would permanently repeal the SGR update mechanism, reform the fee-for-service (FFS) payment...
PECOS Changes Improve Staff Access
CMS rolls out surrogate user program The Centers for Medicare & Medicaid Services (CMS) recently released information about its surrogate user program, which is now available for use. The program authorizes individuals or organizations to work on behalf of...
Medicare DMEPOS for Chiropractor Owned Clinics
Medicare's chiropractic coverage is strictly limited to manipulation of the spine to correct a subluxation. No other chiropractic services or products will be paid by Medicare. Chiropractors may enroll as DMEPOS suppliers, but unlike medical doctors they are not...
Setup EFT For All Payers
Electronic Funds Transfer (EFT or Direct Deposit) is a quick and simple method of receiving reimbursement from payers directly into your bank account as opposed to receiving a paper check. EFT helps to reduce administrative burden of processing paper checks by...
Medicare Provider Enrollment Options Including Opt-Out
Medicare enrolling/enrolled providers have two contractual options with Medicare. 1) Providers may submit an enrollment application and sign a participating (PAR) agreement and accept Medicare's allowed charge as payment in full for all Medicare patients. 2) Providers...
Medicare Enrollment Denial For Outstanding Overpayments
Enrollment regulations allow Medicare contractors to deny an enrollment application for a supplier, physician, or non-physician practitioner if there is an outstanding overpayment that has not been fully repaid at the time of filing the new application. The denial is...
Chiropractic Clinic conversion to Integrated Health Group
We receive many inquiries from Chiropractic practices that are partnering with physicians and mid-level providers to convert their chiropractic practice to a multi-specialty medical clinic providing primary care services, walk-in medical care, chiropractic care, and...
Impact of credentialing on cash flow
Accurate and timely provider enrollment has a dramatic impact on cash flow of any practice. The ultimate goal of any business office, credentialing office, or other responsible staff is to have providers enrolled with health plans as quickly as possible and to...
Medicare DMEPOS Accreditation and Surety Bond Requirements
Certain healthcare providers are exempt from the DMEPOS Accreditation and Surety bond requirements of participating with medicare as a DMEPOS supplier. These exemptions apply to professional services provider who supply DMEPOS products to their patients, and only to...
Medicare Policy Manual – Therapeutic Shoes
The following is an excerpt from the Medicare Benefits Policy Manual, Chapter 15, pertaining to Therapeutic Shoes for individuals with Diabetes. If your practice provides shoe inserts for patients, your billing department should be fully aware of all the related...
Medicare Mental Health Coverage
In March 2012, CMS published a general summary of Mental Health Coverage topics. This summary includes information that impacts Medicare provider enrollment and covered services. COVERED MENTAL HEALTH SERVICES The mental health services that may be covered under the...
Misinformation on Medicare Coverage for Chiropractic Services
CMS published, through The Medicare Learning Network® (MLN), a fact sheet dispelling some myths about coverage for chiropractic services. Below is a summary of key points in the fact sheet published in October 2011. Misinformation #1: There is a 12 visit cap or limit...
