Medical Billing and Coding Healthcare Blog

Governors from multiple states (including Alabama and Virginia) have declared March 31 to be Medical Biller's Day for 2016.

A portion of the proclamation from Alabama reads as follows:

"WHEREAS, Medical Billers provide a much needed service to doctors and other healthcare providers and provide a vital segment of the health care industry; and

"WHEREAS, increasingly, health care providers rely on Medical Billers and Medical Billing companies to assist them in processing claims in accordance with applicable statutes and regulations. Additionally, health care providers consult with medical billing companies for advice regarding reimbursement matters, as well as overall business decision-making; and

"WHEREAS, Medical Billers strive to provide a high level of ethical, lawful and professional conduct throughout the entire health care industry; and

"WHEREAS, Medical Billers offer expertise in carrier reimbursement requirements, help ensure that medical claims are accurately prepared to free physicians and other practitioners to devote their energies to the care of their patients; and

"WHEREAS, Medical Billers continue to influence the medical billing process in a positive and credible manner and should be recognized for their efforts and their loyalty to the Medical Billing Profession."

PGM Billing would like to wish our medical billers and billers nationwide a happy Medical Biller's Day!

The Centers for Medicare & Medicaid Services (CMS) has published three new MLN Matters special edition articles for chiropractors and other practitioners who submit claims to Medicare Administrative Contractors (MACs) for chiropractic services provided to Medicare beneficiaries.

MLN Matters SE1601 is titled "Medicare Coverage for Chiropractic Services – Medical Record Documentation Requirements for Initial and Subsequent Visits." Topics covered include the following:  

  • Documentation requirements for the initial visit
  • Documentation requirements for subsequent visits
  • Necessity for treatment of acute and chronic subluxation
  • ICD-10 codes that support medical necessity for chiropractor services

MLN Matters SE1602 is titled "Use of the AT modifier for Chiropractic Billing," an accompanying article to MM3449 on "Revised Requirements for Chiropractic Billing of Active/Corrective Treatment and Maintenance Therapy, Full Replacement of CR306."

The key point in SE1602 is that for Medicare purposes, a chiropractor must place an -AT modifier on a claim when providing active/corrective treatment to treat acute or chronic subluxation. However, the presence of the -AT modifier may not in all instances indicate that the service is reasonable and necessary. As always, MACs may deny if appropriate after medical review determines that the medical record does not support active/corrective treatment.

MLN Matters SE1603 is titled "Educational Resources to Assist Chiropractors with Medicare Billing." Topics covered include the following:

  • Enrollment information
  • Coverage, documentation and billing
  • Advanced beneficiary notice (ABN) information

For assistance with chiropractic billing, contact PGM Billing, a leading provider of practice management services, including electronic and paper claims filing; claim adjudication; patient and insurance payment posting; patient invoicing, collection and inquiries; and form development.

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