The Practice Building Alliance™

Medical Insurance Techniques, Questions and Training

Pat Atanas CA Training

Managing Medicare Patients Who Are Chronically In Pain

CALLER QUESTION: in regards to Medicare patients who are just chronically in pain. What’s the best way to manage those people? We’ve been telling people that we’re less likely to get flagged or their care is more likely to get covered if they come for spurts of care, and then take a break; and then spurts of care, and take a break. But I don’t know what the best way is to handle those people who are just chronically sore all the time. They benefit, they get from pain relief and functional relief from the care, but they’re never going to get better. John: Yeah. Well, that’s a great question, because Medicare does pay for chronic care as well, or chronic conditions, and [...]

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How Hard Is It To Become a DME Supplier

CALLER QUESTION: How hard is it to become a DME supplier? John: Well, if you do everything the right way, it’s not hard at all. You just follow all the little points that I give you in the program, and it’ll take you about 2 months. You have to fill out an application, but I have a sample application. There’s some forms there, a letter of medical necessity. It’s just filling out the application, which is going to take the most time, and then submit to Medicare. They come out and do a site inspection, and they give you a number. I think it lasts for 2 years, and they come back and they do another site inspection. I’m not going to [...]

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Medicare and Pain Relief

CALLER QUESTION: Let’s say the patient comes in on a day-to-day basis and they’re checking pain levels, or they’re writing down kind of how it is that they’re progressing, does Medicare cover pain relief? John: Yeah. Anyway, Medicare does not pay for pain relief, and you have to let your patients know that, when they first come in, that Medicare does not pay for all chiropractic services. In fact, I did a call with Ben a few weeks ago, and I’ve got these 3 programs that I’ve put together. One is called “Managing Medicare in Chiropractic.” It has the exact history that Medicare wants, and that you need to get paid. And then they have talking about how to objectively [...]

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How To Bill Insurance Companies For Cold Laser Therapy

CALLER QUESTION: My question’s about cold laser therapy for muscle spasm and inflammation. How do we bill insurance companies for that? John: Cold laser. I have a code written down here for that. There is a code. It’s not a CPT code, though, it is called a HCPCS code. Oh, what do I have for that? Hold on one second. Let me look this up, because I had just looked at this last week. Okay, low-level is S8948. That’s low-level laser, each 15 minutes. Caller: Okay, and then what would be the appropriate charge to bill for this? That’s one thing we haven’t been able to find any information on. John: That’s kind of a tough one there. You really have to [...]

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GA, GX, and GY Modifiers Used With Medicare

CALLER QUESTION: I got a quick question. Shouldn’t be too hard. It’s with the GA, GX, and GY modifiers that you use with Medicare. I’ve been using the GA, but with the material I got from you, and reading, and also I had a seminar, I usually do the GA right away on the first visit, and it shows my initial exam, maintenance visits, that’s not being covered. Okay? The webinar that I was listening to it kind of was saying that the GA is just for the maintenance visits. There’s a GX modifier for x-ray, and a GY for the exam. Is this correct? John: Here’s the way it’s supposed to work, the way I understand it. The GA modifier [...]

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Billing an Adjustment Code Like The 98941 Code

CALLER QUESTION: Can we, instead of billing an adjustment code like the 98941 code, on any given day, say we would render that service, but instead of billing that code, could we actually bill an office visit instead? John: No, and I’ll tell you why. A couple different reasons. First of all, the introduction to the CPT Code Book says to bill the code that accurately describes the service that you provided. Now, I realize that if you provide a service like manipulation, there’s going to be more than one code that you can actually bill. For example, you perform a manipulation, you could bill a chiropractor manipulative treatment, an osteopathic manipulative treatment, you could bill a 97140; that’s manipulation as well. Answering that, the [...]

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