THE BASICS OF MEDICARE presented by The New York Chiropractic Council Speaker Dr' John LaMonica Insu

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THE BASICS OF MEDICAREpresented by The New York
Chiropractic CouncilSpeakerDr. John
LaMonicaInsurance Committee Chairperson
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Medicare Chiropractic Services, Policies and
Guidelines
Introduction Basics of Medicare Chiropractic in
CMS Medicare Categories of Condition Par/Non
Par Fee Schedule/Limiting Charge Documentation
CPT Code and ICD 9 Linkage to support Medical
Necessity Defining Medical Necessity on Medicare
Pts. Modifiers P.A.R.T. Demystified Daily Note
requirements for documentation CMS Utilization
Guideline Review Parameters X-Ray Requirement
Advanced Beneficiary Notice Completion of the
CMS 1500 Key elements in the Filing of the CMS
for Correct Communication Crossover
Claims Filing Guidelines Denials Appeals
National Provider Identifier Number (NPI)
Medicare Seminars and Resources Questions and
Answers
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Indications and Limitations of Coverage and/or
Medical Necessity

• Chiropractic service is eligible for
  reimbursement but is specifically limited by
  Medicare to treatment by means of manual
  manipulation (i.e., by use of the hands) of the
  spine for the purpose of correcting a
  subluxation. For the purpose of Medicare,
  subluxation is defined as an intervertebral
  motion segment in which alignment movement
  integrity and/or physiological function of the
  spine are altered although contact between
  intervertebral joint surfaces remains intact, and
  usually falls into one of three categories

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Indications and Limitations of Coverage and/or
Medical Necessity

• Acute subluxation A patients condition is
  considered acute when the patient is being
  treated for a new injury, identified by x-ray or
  physical exam. The result of chiropractic
  manipulation is expected to be an improvement in,
  or arrest of progression, of the patients
  condition.
• Chronic subluxation A patients condition is
  considered chronic when it is not expected to
  significantly improve or be resolved with further
  treatment (as is the case with an acute
  condition), but where the continued therapy can
  be expected to result in some functional
  improvement. Once the clinical status has
  remained stable for a given condition, without
  expectation of additional objective clinical
  improvements, further manipulative treatment is
  considered maintenance therapy and is not
  covered.
• Nerve root problems, such as a pinched nerve,
  when they are the result of acute or chronic
  subluxations as described above.
• Medicare reimburses additional manipulation for
  the same problem when an exacerbation or
  recurrence occurs
• Exacerbation
• An exacerbation is a temporary, marked
  deterioration of the patient's condition due to
  an acute flare-up of the condition being treated.
  This must be documented in the patient's clinical
  record, including the date of occurrence, nature
  of the onset, or other pertinent factors that
  will support the medical necessity of treatments
  for this condition.
• Recurrence
• A recurrence is a return of symptoms of a
  previously treated condition that has been
  quiescent for 30 or more days. This may require
  the reinstitution of therapy.

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Acceptable terminology for the manipulative
treatment being provided includes

• Spine or spinal adjustment by manual means
• Spine or spinal manipulation
• Manual adjustment and
• Vertebral manipulation or adjustment

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Indications

• The patient must have a subluxation of the spine,
  as defined in the Description section of the LCD.
• A patient must have a significant health problem
  in the form of a neuro-musculoskeletal condition
  related to a subluxation necessitating
  treatments. The manual manipulative services
  rendered must have a direct therapeutic
  relationship to the patient's condition and
  provide reasonable expectation of recovery or
  improvement of function.
• Spinal axis aches, strains, sprains, nerve pains
  and functional mechanical disabilities of the
  spine are considered to be medically necessary
  therapeutic grounds for chiropractic manipulative
  treatment.
• The following are some examples of acceptable
  descriptive terms for the nature of the
  abnormalities

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Indications

• Off-centeredMisalignmentMalpositioningSpacing
• abnormal
• altered
• decreased
• increased Incomplete dislocationRotationListhesi
  s
• antero
• postero
• retro
• latereol
• spondylo
• Motion
• limited
• lost
• restricted
• flexion
• extension
• hyper mobility
• hypomotility
• aberrant

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Par vs. Non Par

• There are two categories of providers in CMS
  Medicare. They are non-participating and
  participating. You must be one or the other as
  chiropractors are not permitted to opt out of the
  CMS system.
• Participating means you are a medicare provider
  who is in the Medicare network and automatically
  accept assignment of the medicare benefits.
• Non-participating means you are a medicare
  provider in the Medicare system and you do not
  accept assignment automatically. You maintain the
  option of fee for service charges at the time of
  service.
• There are benefits and consequences of each
  category.
• If you are participating you are paid the
  participating fee, which is slightly higher than
  the nonparticipating fee.

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Par vs. Non Par

• As a non participating provider you have the
  option of accepting assignment or not.
• If you accept assignment you are paid the
  non-participating fee, which is slightly less
  than the participating fee.
• You may also elect to charge a fee for service
  and give the patient a bill for reimbursement
  purposes. In this case you are only allowed to
  charge as a maximum the LIMITING CHARGE.
• The patient will only be reimbursed 80 of the
  non-participating fee.
• The maximum charge to a medicare patient is the
  limiting charge!

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FEES

• As there are two carriers in NYS that administer
  Medicare benefits we will outline the new 2006
  fees for Medicare Services.
• Empire Medicare
• Service Par Fee Non Par Fee Limiting Charge
• 98940 28.42 27.00 31.05
• 98941 39.28 37.32 42.92
• 98942 51.07 48.52 55.80
• GHI Medicare
• Service Par Fee Non Par Fee Limiting Charge
• 98940 27.46 26.26 30.05
• 98941 38.21 36.30 41.75
• 98942 49.71 47.22 54.30

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Limitations

• Once the functional status has remained stable
  for a given condition, further manipulative
  treatment is considered maintenance therapy and
  is not covered. Maintenance therapy (e.g., a
  treatment plan that seeks to prevent disease,
  promote health, prolong and enhance the quality
  of life, or therapy that is performed beyond the
  stabilization of a chronic condition) is not a
  Medicare benefit.
• Chiropractic manipulative treatment is an
  excluded service under Medicare for most spinal
  diseases and pathologies other than those listed
  in the Indications section. Examples of these
  (not an all inclusive list) are rheumatoid
  arthritis, muscular dystrophy, multiple
  sclerosis, pneumonia, and emphysema.
• The subluxation must be causal, i.e., the
  symptoms must be related to the level of the
  subluxation that has been cited. A statement on a
  claim that there is "pain" is insufficient. The
  location of pain must be described and whether
  the particular vertebra listed is capable of
  producing pain in the area determined.

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Limitations

• The need for an extensive, prolonged course of
  treatment must be clearly documented in the
  medical record. Treatment should result in
  improvement or arrest of deterioration of
  subluxation within a reasonable and generally
  predictable period of time. Acute subluxation
  problems (e.g., strains or sprains) may require
  as many as three months of treatment but some
  require very little treatment. In the first
  several days, treatment may be quite frequent but
  may decrease in frequency with time or as
  improvement is obtained.
• Coverage will be denied for lack of reasonable
  expectation that the continuation of treatment
  would result in significant or functional
  improvement of the patient's condition. Continued
  repetitive treatment without an achievable and
  clearly defined goal is considered maintenance
  therapy and is not covered.
• Only a single manipulation service (98940, 98941,
  or 98942) may be billed on any one date of
  service by the same or different providers unless
  documentation of the reasonableness and necessity
  for additional treatment is submitted with the
  claim.

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Spinal and Extra-Spinal Regions

• SPINAL REGIONS
• CERVICAL (INCLUDES THE ATLANTO-OCCIPTAL JOINT)
• THORACIC (INCLUDES THE COSTOTRANSVERSE AND
  COSTOVERTEBRAL JOINTS
• LUMBAR
• SACRAL
• PELVIC (SACRO-ILLIAC JOINT)
• EXTRASPINAL REGION
• HEAD (INCLUDING TEMPOROMANDIBULAR JOINT,
  EXCLUDING ATLANTO-OCCIPITAL JOINT)
• LOWER EXTREMITIES
• UPPER EXTREMITIES
• RIB CAGE ( EXCLUDING COSTOTRANSVERSE AND
  COSTOTRANSVERSE JOINTS)
• ABDOMEN

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CPT/HCPCS Codes

• 98940 Chiropractic manipulative treatment (CMT)
  spinal, one to two regions
• 98941 Chiropractic manipulative treatment (CMT)
  spinal, three to four regions
• 98942 Chiropractic manipulative treatment (CMT)
  spinal, five regions
• 98943 Chiropractic manipulative treatment
  extraspinal, one or more regions (not covered by
  medicare)

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ICD-9-CM Codes that Support Medical Necessity

• TRUNCATED DIAGNOSIS CODES ARE NOT ACCEPTABLE.
• ICD-9-CM code listings may cover a range and
  include truncated codes. It is the providers
  responsibility to avoid truncated codes by
  selecting a code(s) carried out to the highest
  level of specificity and selected from the
  ICD-9-CM book appropriate to the year in which
  the service was performed.
• It is not enough to link the procedure code to a
  correct, payable ICD-9-CM code. The diagnosis or
  clinical signs/symptoms must be present for the
  procedure to be paid.
• Further, these ICD-9-CM codes can be used only
  with the conditions listed in the Indications and
  Limitations sections of this LCD
• Primary ICD-9-CM Codes
• 739.0 Nonallopathic lesions of head region not
  elsewhere classified
• 739.1 Nonallopathic lesions of cervical region
  not elsewhere classified
• 739.2 Nonallopathic lesions of thoracic region
  not elsewhere classified
• 739.3 Nonallopathic lesions of lumbar region not
  elsewhere classified
• 739.4 Nonallopathic lesions of sacral region not
  elsewhere classified
• 739.5 Nonallopathic lesions of pelvic region not
  elsewhere classified
• 739.8 Nonallopathic lesions of rib cage not
  elsewhere classified

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Documentation Requirements

• Each claim must be submitted with ICD-9-CM codes
  that reflect the condition of the patient, and
  indicate the reason(s) for which the service was
  performed. Claims submitted without ICD-9-CM
  codes will be returned.
• Documentation must be available to Medicare upon
  request.
• The precise level of subluxation must be
  specified by the chiropractor to substantiate a
  claim for manipulation of the spine, including
  that the level of spinal subluxation must bear a
  direct causal relationship to the patient's
  symptoms, and the symptoms must be directly
  related to the level of the subluxation that has
  been diagnosed.
• The following information must be documented in
  the patient's medical record for the Initial
  Visit, whether the subluxation is demonstrated by
  x-ray or by physical examination
• History
• Chief complaint including the symptoms present
  that caused the patient to seek chiropractic
  treatment
• Family history if relevant
• Past health history including general health
  statement, prior illness(es), surgical history,
  prior injuries or trauma, past hospitalizations
  (as appropriate), medications.
• Description of present illness including
• Mechanism of trauma
• Quality and character of problem/symptoms
• Onset, duration, intensity, frequency, location
  and radiation of symptoms
• Aggravating or relieving factors
• Prior interventions, treatments, medications,
  secondary complaints and
• Symptoms causing patient to seek treatment.

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Documentation Requirements

• The record should document that these symptoms
  bear a direct relationship to the level of
  subluxation. The symptoms should refer to the
  spine (spondyle or vertebral), muscle (myo), bone
  (osseo or osteo), rib (costo or costal) and joint
  (arthro) and be reported as pain (algia),
  inflammation (itis), or as signs such as
  swelling, spasticity, etc. Rib and rib/chest
  pains are recognized symptoms, but the record
  should document that the symptoms are related to
  the spine. (The subluxation must be causal, i.e.,
  the symptoms must be related to the level of the
  subluxation that has been cited.) The location of
  pain must be described and whether the particular
  vertebra listed is capable of producing pain in
  the area determined.
• Evaluation of musculoskeletal/nervous system
  through physical examination.
• Diagnosis The primary diagnosis must be
  subluxation, and must indicate the level of the
  subluxation. The secondary diagnosis (category I,
  II, or III) must reflect the neuromusculoskeletal
  condition necessitating the treatment.
• Treatment Plan The treatment plan should include
  the following
• Recommended level of care (duration and frequency
  of visits)
• Specific treatment goals and
• Objective measures to evaluate treatment
  effectiveness.
• Date of initial treatment or date of
  exacerbation/recurrence

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Documentation Requirements

• The following documentation is required for
  Subsequent Visits
• History, including
• review of chief complaint
• changes since last visit
• system review if relevant.
• Physical examination, including
• exam of area of spine involved in diagnosis
• assessment of change in patient condition since
  last visit
• evaluation of treatment effectiveness.
• Documentation of treatment given on day of visit.
  

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Modifiers

• MEDICARE SPECIFIC
• AT - Denotes ACTIVE TREATMENT Phase of Care
• GA - Tells Medicare you have the ABN signed
• GY - Item or Service is Statutorily excluded or
  does not meet the definition of any Medicare
  Benefit
• GZ - Item or service expected to be denied as not
  reasonable and necessary. (ABN is not signed.)

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P.A.R.T.

• The P.A.R.T. evaluation process is recommended as
  the examination alternative to the previously
  mandated demonstration of subluxation by
  x-ray/MRI/CT for services beginning January 1,
  2000. The acronym P.A.R.T. identifies diagnostic
  criteria for spinal dysfunction (subluxation).
• P - Pain/tenderness The perception of pain and
  tenderness is evaluated in terms of location,
  quality, and intensity. Most primary
  neuromusculoskeletal disorders manifest primarily
  by a painful response. Pain and tenderness
  findings may be identified through one or more of
  the following observation, percussion,
  palpation, provocation, etc. Furthermore, pain
  intensity may be assessed using one or more of
  the following visual analog scales, algometers,
  pain questionnaires, etc.
• A - Asymmetry/misalignment Asymmetry/misalignment
  may be identified on a sectional or segmental
  level through one or more of the following
  observation (posture and heat analysis), static
  palpation for misalignment of vertebral segments,
  diagnostic imaging, etc.
• R - Range of motion abnormality Changes in
  active, passive, and accessory joint movements
  may result in an increase or a decrease of
  sectional or segmental mobility. Range of motion
  abnormalities may be identified through one or
  more of the following motion palpation,
  observation, stress diagnostic imaging, range of
  motion, measurement(s), etc.
• T - Tissue tone, texture, temperature
  abnormality Changes in the characteristics of
  contiguous and associated soft tissue including
  skin, fascia, muscle and ligament may be
  identified through one or more of the following
  procedures observation, palpation, use of
  instrumentation, test of length and strength,
  etc.

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P.A.R.T

• To demonstrate a subluxation based on physical
  examination, two of the four criteria mentioned
  above, one of which must be asymmetry/misalignment
  or range of motion abnormality, should be
  documented.
• Documentation of changes in the patients
  examination, status, progression and care plan
  should be maintained in the records at each
  visit.
• The evaluation process must be an ongoing
  procedure. Even if a complete and thorough
  examination can be completed during the first
  visit, signs and certain symptoms must be
  rechecked during the course of treatment to
  determine the extent of the patient progress.
  This ongoing evaluation and assessment forming
  the basis for treatment modification is a key
  factor in total patient management. The initial
  examination, no matter how thorough, cannot be
  expected to provide all the answers. A treatment
  trial should be instituted with its effects
  assessed to determine whether it should be
  continued or a different plan devised. Moreover,
  it is the examination that forms the foundation
  for treatment, guiding the doctor in selecting
  appropriate treatment techniques, frequency, and
  course of treatment.
• The Carrier will seek consultation from a
  chiropractic physician to evaluate medical
  records, as necessary
• Documentation must be legible and must be
  available to Medicare upon request. Failure to
  provide this may result in denial of claim(s).

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Utilization Guidelines

• For acute and uncomplicated pain it is
  anticipated that patients may receive treatment
  three times a week for two weeks, then 1-3 times
  a week for two weeks. If there is improvement
  then treatment may continue for an additional
  four weeks. After six weeks treatment should
  usually be only 1-2 treatments per week.
• For chronic pain and acute complicated pain
  patients may receive treatment at three times a
  week for 4-6 weeks, and then two times a week for
  another 4-6 weeks. Treatment should usually be
  less than 12-16 weeks.
• Episodes of care exceeding once per condition
  will be reimbursed only if there is an
  exacerbation documented in the medical record.
  Otherwise, the service will be considered
  maintenance.
• Services in excess of these parameters may be
  suspended for prepay review, or reviewed postpay.
• adapted from Chapman-Smith Jonas, The
  Chiropractic Profession Its Education, Practice,
  Research and Future Directions, NCMIC Group, Inc
  reference Mercy Center Consensus Conference and
  Clinical Guidelines for Chiropractic Practice in
  Canada

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Sources of Information and Basis for Decision

• Foundations of Chiropractic Quality Assurance and
  Practice Parameters Gatterman. Mosby Year Books,
  1995
• Guidelines for Chiropractic Quality Assurance and
  Practice Parameters ed. Haldeman, Chapman-Smith,
  Peterson. Aspen Publication, 1993
• Chiropractic Physician Consultants
• Other Medicare Part B carriers' local medical
  review policies, e.g., Colorado, Iowa, Kansas,
  Michigan, Empire New Jersey, Upstate Medicare
  Division, NY.
• Meeting with Chiropractic CAC representative (NY)
  
• Submitted comments from chiropractors in NY and
  NJ.
• Travell, Janet G., M.D. and Simons, David G.,
  M.D., Myofascial Pain and Dysfunction, The
  Trigger Point
• Manual, Williams Wilkins, Chapter 7, pp
  202-207
• Diagnosis to Treatment Planner, A ChiroCode
  Companion, Care and Healing Parameters, pp
  319-326
• Procedural Utilization Facts, Data Management
  Ventures, Inc., Treatment Classification Levels
  of Care, Utilization Review, pp 107-123

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X-rays/MRI/CT Scan

• For dates of service prior to January 1, 2000, a
  documenting x-ray, (or existing MRI or CT scan)
  must have been taken at a time reasonably
  proximate to the initiation of a course of
  treatment, unless in the carrier's judgment more
  specific diagnostic imaging evidence is
  warranted.
• Effective for claims with dates of service on or
  after January 1, 2000, an x-ray is not required
  to demonstrate the subluxation. However, an x-ray
  may be used for this purpose if the chiropractor
  so chooses. If an x-ray, (or existing MRI or CT
  scan) is used for documentation, it must have
  been taken no more than twelve (12) months prior
  to, or three (3) months following the initiation
  of a course of treatment.
• In certain cases of chronic subluxation, an older
  x-ray (or existing MRI or CT scan) may be
  accepted, provided the beneficiary's health
  record indicates the condition has existed longer
  than twelve (12) months, and there is reasonable
  grounds for concluding that the condition is
  chronic.
• Videofluoroscopy of the spine is not an accepted
  method for diagnosing subluxation for
  chiropractic manipulation.
• The x-ray/MRI/CT scan must be made available to
  Medicare when requested. If the diagnostic
  studies have been taken in a hospital or
  outpatient facility, a written report, including
  interpretation and diagnosis by a physician must
  be present in the patient's medical record.
• The chiropractor's review of the x-ray (or
  existing MRI or CT scan) should be documented,
  noting the level of subluxation. The film(s) must
  be labeled with the patient's name and date they
  were taken, and must be marked right or left.
• Although a chiropractor may not order an x-ray,
  he/she may refer the beneficiary for an x-ray and
  the authorized ordering practitioner may accept a
  referral for an x-ray. In this case, the
  authorized ordering practitioner must maintain
  adequate documentation to support the medical
  necessity for the service.
• Section 240 of the CMS Pub 100-2, Chapter 15
  stipulates that judgments about the
  reasonableness of chiropractic treatment must be
  based on the application of chiropractic
  principles. Therefore, CMS has determined that if
  the opinions of a radiologist and a chiropractor
  conflict as to the existence of a subluxation
  (for a chiropractic patient), then the opinion of
  the chiropractor takes precedence.

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Coding Guidelines

• The guidelines of the Correct Coding Initiative
  supersede all coding instructions in the LCD.
• The diagnosis code(s) must best describe the
  patients condition for which the service was
  performed.
• Two diagnoses are required on all claims, and on
  claims for patients whose condition is
  exacerbated, a third diagnosis is also required.
  The precise level of the subluxation must be
  listed as the primary diagnosis, while the
  resulting disorders are to be listed as the
  secondary diagnosis. For exacerbated conditions,
  report ICD-9-CM code V58.9.
• The date of the initial treatment or date of
  exacerbation of the existing condition must be
  entered in item 14 of the CMS-1500 form or the
  electronic equivalent.
• If using an x-ray as documentation of the
  subluxation, the date of the x-ray (or existing
  MRI or CT scan) must be entered in Item 19 of the
  CMS-1500 form or the electronic equivalent.
• Diagnostic x-rays, evaluation and management
  services and physical therapy are not covered
  when performed by chiropractors. When submitted
  for a denial for the purposes of secondary
  coverage, these services may be coded utilizing a
  "GY" modifier so that proper denials will be
  shown on the Explanation of Medicare Benefits
  form.
• If an authorized ordering practitioner orders the
  x-ray, then he/she should enter his/her name in
  item 17 of the CMS-1500 form and his/her own UPIN
  number in item 17a of the CMS-1500 form, or the
  electronic equivalent, as the ordering physician.
• Effective for dates of service on or after
  October 1, 2004, modifier AT (acute treatment)
  must be reported for all claims for
  active/corrective treatment.

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Coding Guidelines

• Claims for maintenance therapy must be submitted
  without modifier AT.
• If the chiropractic physician believes that
  manipulation services may be considered not to be
  reasonable and necessary, i.e., has exceeded the
  frequency limits established for that service,
  he/she may have the beneficiary sign a waiver of
  liability statement prior to providing the
  service. The waiver must indicate the specific
  reason why the chiropractor believes Medicare may
  not reimburse the service. The service should be
  submitted with a GA modifier, indicating that a
  waiver has been obtained, and include a copy of
  the waiver if submitting a paper claim. The GA
  modifier is informational only and does not
  trigger an automatic denial, i.e., the service
  could be paid by Medicare. Therefore, the
  provider should wait for the claim to be
  processed before billing the beneficiary for a
  denied service subject to the waiver of
  liability. If the provider has not obtained a
  waiver of liability from the beneficiary,
  modifier GZ should be reported with the claim.
• Chiropractic services may be performed in the
  office (11), home (12), assisted living facility
  (13), group home (14), inpatient hospital (21),
  outpatient hospital (22), emergency room (23),
  nursing facility for patients in a Part A stay
  (31), nursing facility for patients no longer in
  a Part A stay (32), custodial care facility (33),
  independent clinic (49), comprehensive outpatient
  rehabilitation facility (62), and state or local
  public health clinic (71).

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Other Comments

• This LCD was developed/revised as a joint
  document for Empire Medicare Services New York
  and New Jersey.
• Manual devices (those devices that are hand-held
  with the thrust of the force of the device being
  controlled manually) may be used by the
  chiropractor in performing manual manipulation of
  the spine. However, no additional payment is
  allowed for the use of the device or for the
  device itself.
• No other diagnostic or therapeutic service
  furnished by a chiropractor or under his or her
  order is covered. This means that if a
  chiropractor orders, takes, or interprets an
  x-ray, or any other diagnostic test, the x-ray or
  other diagnostic test can be used for claims
  processing purposes, but Medicare coverage and
  payment are not available for those services. The
  following are examples (not an all inclusive
  list) of services that, when performed or ordered
  by the chiropractor, are excluded from Medicare
  coverage and for which the beneficiary is
  responsible for payment

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COORDINATION OF BENEFITS/CROSSOVER CLAIMS

• On the Medicare EOB (explanation of benefits) you
  receive, Medicare will tell you if there was a
  coordination of benefits or crossover claims.
• This will tell you if the claims was submitted to
  the secondary carrier.

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Other Comments

• Therapy for a chronic condition that does not
  meet the definition as described in the
  "Indications and Limitations" section of this LCD
  
• Maintenance therapy
• Laboratory tests
• X-rays/MRI/CT Scans
• Evaluation and management services
• Physiotherapy
• Traction
• Supplies
• Injections
• Drugs
• EKGs or any diagnostic study
• Acupuncture
• Orthopedic devices
• Nutritional supplements/counseling
• Any service ordered by the chiropractor
• Any manipulation where there exists one of the
  absolute contraindications
• Mechanical or electric equipment that is used for
  manipulations and does not meet the definition of
  "manual device" as specified in the "Description"
  section of this policy
• Any manipulation where the x-ray (or existing MRI
  or CT scan) or examination does not support one
  of the primary diagnoses listed in the "ICD-9-CM
  Diagnoses That Support Medical Necessity" section
  of this LCD.

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Other Comments

• A radiologist (or another authorized ordering
  practitioner) may accept a referral for an x-ray
  by doctors of chiropractic. The chiropractor may
  not order the x-ray.
• Program Exclusions
• Treatment of certain conditions may be excluded
  from coverage if it falls outside the scope of a
  chiropractor's practice as defined by State Law.
• Some chiropractors have been identified as using
  an "intensive care" concept of treatment. Under
  this approach, multiple daily visits (as many as
  four or five in a single day) are given in the
  office or clinic and so-called room or ward fees
  are charged, since the patient is confined to bed
  usually for the day. The room or ward fees are
  not covered.

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Denials and Appeals
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Appointment of Representative
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Medicare Re-determination Request Form
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MEDICARE RECONSIDERATION REQUEST FORM
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TRANSFER OF APPEAL RIGHTS
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NPI National Provider Identification

• A national number to be assigned to all providers
  by the Federal Government.
• You can apply for it now!
• Schedule of use
• 5/23/2005-1/02/2006 UPIN
• 1/3/2006-10/01/2006 UPIN or Both
• 10/2/2006-5/22/2007 UPIN and/or NPI
• Post 5/23/2007 only NPI

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Helpful Web Links

• www.ghimedicare.com
• www.empiremedicare.com
• www.chirocode.com
• www.cms.gov