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Medicare – When to Collect for Non-Covered Services?

Curious about collecting payments for non-Medicare covered services? Tune in as we explore this topic in our latest video – watch now to gain insights!

Relevant link for today:

Medicare Claims Processing Manual



We seem to be in a season with a lot of Medicare questions. And one of the more recent questions we received from a member was, when can we collect from a patient? The amounts that are due and specifically this question was in regards to those amounts of Medicare is never going to pay on whether it be a maintenance spinal adjustment that you have an ABN form for, or if it’s a non-covered service for chiropractic physicians, such as exams, X rays, and modalities and therapies. In both of those cases, the answer is actually the same. You can collect on the date of service, as long as you’ve dotted your I’s and cross your t’s.

The first thing is, let’s talk about those covered services that are not reimbursable by Medicare. So if you’re doing a spinal adjustment, that is maintenance in nature, and we’ve got a lot of videos and articles telling you when to get the ABN form signed, but you need to have an ABN form signed in those particular cases, and you’re going to bill maintenance care to Medicare, without the AT modifier appended to that to that service line. So in these cases, of course, you’re going to have an ABN form on file, what does Medicare say? Medicare says that the provider may bill and collect funds from the beneficiary, the patient for noncovered items or services immediately after the ABN form is signed. So when the service has been when you have the ABN form signed prior to the service, and then the services performed at that point, then you can bill for those services. And so that is for maintenance, spinal adjustments, but what about services that are not maintenance in nature? What if you’re doing X-ray exams? Are you doing physical therapy and those particular cases, also because they’re not covered by Medicare, you can collect those on the date of service, however, you need to dot some i’s and cross some T’s.

You want to make sure that you actually have a line inside of your financial responsibility, your financial form and document that the patient signs and agrees that they’re going to be responsible for these charges, and notify them that under Medicare, the only thing that Medicare covers are those active treatments, spinal adjustments, and all other services are will be the responsibility of the patient and go through that. You could also do a report of findings of financial reported findings where you’ve gone through all of those charges with the patient. So they’re intimately familiar with what’s not covered and what is covered. And of course, you want to have them sign that of course the financial policy, they’re also going to sign as well. That’s important, but in either of those cases, so we’re maintenance care, that you have an ABN form signed and for noncovered, statutorily noncovered Medicare services you can collect at the time of service. We’ll catch you next week.

About Author

Marc Abla, CAE

Marc Abla began working at the Illinois Chiropractic Society in 2002 and became the Executive Director in 2008. He brings his extensive financial, administrative and association experience to the ICS. He is a Certified Association Executive and a graduate of the Certified Leadership Series through the Illinois Society of Association Executives. Additionally, he is a member of the Illinois Society of Association Executives, the American Society of Association Executives, Association Forum, Congress of Chiropractic State Associations, and the American Chiropractic Association.

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