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Medicare

MEDICARE:

Medicare is an ever changing federal government insurance SUPLEMENTAL program.

It is NOT intended to be a primary insurance policy, and does not do an adequate job of providing anything more than the absolute minimum bare essential acute care.

As such, the coverage/benefits are extremely limited in scope and in duration.

As you will see in the attached sample ABN form below:  (This is Medicare’s own form)

Medicare benefits at a Chiropractic office  ONLY covers SPINAL Manipulation ;

IF & Only IF:  it is determined by Medicare that it is an Acute Condition ( usualy due to a recent incident);    And if it is determined to be MEDICALLY NESCESSARY  as supported by stringent documentable objective findings.

We will do our best to determine whether your condition May meet these stringent requirements , and is likely to be accepted as covered, prior to beginning treatment.

This way you will have an idea of what they might pay for,  and what you may be responsible for.

Here is a quick list of what & why various services may not be covered; and the approximate cost of each.

They MAY pay for Spinal Adjustments only.

They will NOT pay for treatment to any other issue including shoulders , arms, legs, etc…

They will NOT pay for EXAMS or X-rays or Therapy.

( there is some talk of some of this changing sometime in the future)

Medicare May Not Pay:

1 Chiro adjustment to Spinal areas  (sometimesYES, sometimes NO)

2 Chiro adjustment to extremities :   arms, legs , shoulders, feet etc...

3 Examinations (of any sort)             

4 (a) x-rays (b) lab work

5  Manual therapy  : massage, myofascial release, etc...

6 Physiotherapy :   Ultrasound , Electrical Stim...

7 Rehab therapy (exercise)

8 Traction / decompression

9 Nutritional supplements

10 Orthotics, Braces, Supports. (under some conditions , Maybe.)

If it appears likely that your condition will not be covered;         We will discuss the various treatments, costs, and payment options available for you to choose from.

Below is the government form :  Advanced Bennificiary Notice ;

which offices are required to give any Medicare patient,  PRIOR to performing ANY service they think has any likelihood of being denied or not covered.

This is so you can make an informed decision ahead of time,  whether or not You want to assume the risk of possibly having to pay for it yourself…. 

We have filled in the box (D) (E)  (F)  as an example.


 Advance Beneficiary Notice of Noncoverage (ABN)

(A) Notifier(s):    Dr. J. Scott Crill DC.

 (B) Patient Name:                                                                      (C) Identification Number:

NOTE:  If Medicare doesn’t pay for (D)___1-10_______  below, you may have to pay.

Medicare does not pay for everything, even some care that you or your health care provider have good reason to think you need. We expect Medicare may not pay for the (D___1-10___ below.

(D)                               

(E) Reason Medicare May Not Pay:

(F) Estimated

     Cost:

1 Chiro adjustment to Spinal areas

2 Chiro adjustment to extremities

3 Examinations (of any sort)             

4 (a) x-rays (b) lab work

5  manual therapy (ex: massage)

6 Physiotherapy  (U/S, E-Stim)

7 Rehab therapy (exercise)

8 Traction / decompression

9 Nutritional supplements

10 Orthotics, Braces, Supports.

1)  Medicare MAY not pay for chiropractic treatment of: Conditions,  situations,  or Diagnoses that they may determine to be: (Stable, Chronic, Non Accute,  Maintenance, preventative, excessive or not Medically Necessary)

(2-10)   Medicare does not pay for ANY service other than adjustment to the spine only, performed by a chiropractor.

1)  $35-55

2)  $25

3) $25-200

4a) $50-250

4b)  $100-500

5-8)  $15-60

9)   $10-100

10) $40-400

What you need to do now:

  • Read this notice, so you can make an informed decision about your care.
  • Ask us any questions that you may have after you finish reading.
  • Choose an option below about whether to receive the (D)_____________listed above.

Note:  If you choose Option 1 or 2, we may help you to use any other insurance that you might have, but Medicare cannot require us to do this.

(G) Options:             Check only one box.  We cannot choose a box for you.

OPTION 1.  I want the (D)__ _______ listed above.  You may ask to be paid now, but I also want Medicare billed for an official decision on payment, which is sent to me on a Medicare Summary Notice (MSN).  I understand that if Medicare doesn’t pay, I am responsible for payment, but I can appeal to Medicare by following the directions on the MSNIf Medicare does pay, you will refund any payments I made to you, less co-pays or deductibles. 

OPTION 2.   I want the (D),________ listed above, but do not bill Medicare.  You may ask to be paid now as I am responsible for payment. I cannot appeal if Medicare is not billed.   

OPTION 3. I don’t want the (D) ______ _listed above.  I understand with this choice  I am not responsible for payment, and I cannot appeal to see if Medicare would pay.

(H) Additional Information: This notice gives our opinion, not an official Medicare decision.  If you have other questions on this notice or Medicare billing, call 1-800-MEDICARE (1-800-633-4227/TTY: 1-877-486-2048). 

Signing below means that you have received and understand this notice. You also receive a copy. 

(I) Signature:

(J) Date:   xx/xx/xx

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number.  The valid OMB control number for this information collection is 0938-0566.  The time required to complete this information collection is estimated to average 7 minutes per response, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection.  If you have comments concerning the accuracy of the time estimate or suggestions for improving this form, please write to: CMS, 7500 Security Boulevard, Attn: PRA Reports Clearance Officer, Baltimore, Maryland 21244-1850.                                                                                                              

Form CMS-R-131 (03/08)                                                                        Form Approved OMB No. 0938-0566

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