like having a Medicare I called, I call it a Medicare monster which is an office subluxation. All you got to do is do the right adjustment and you can fix anything in the office in a simple form if you just take the time and simple steps to do it just like Dr. Sam said. Ken, I want to come back to one thing that you indicated. That was you talked about discounted fees. You said that Medicare allows for 5 to 15% discount. Did I understand that correctly or is that a general rule that gets followed across the board? That's an OIG opinion and that's opinion number 0803 where they're saying between 5 to 15% and normally, that's going to apply to non-coverage services. It's not going to apply to your basic manipulation. Again, you want to make sure that whatever service you provide whether it be a coverage service or a non- coverage service, you understand how to deal with the documentation for that service and what the rules are if the [inaudible 00:36:36] service in your opinion or the patient's request is to reduce the fee for the service. That's a very big issue right now. Again, that's one of the things that comes up in audits quite frequently. I know a number of doctors that I've consulted with Medicare audits., they get hammered on some of those things because they're offering, they're trying to have people get good quality chiropractic care but they're offering services to get them in the office which may not be the correct way to do that. Thanks, Ken. I want to come back to something that you said a little earlier, Sam. You mentioned the ABN forms. ABN forms are the forms that are legally necessary to charge a Medicare recipient for any service that Medicare does not pay for. I want to ask you a couple of questions. I want you to elaborate on that a little bit because I think that there is a lot of misunderstanding. Some doctors don't even know what the heck an ABN form is let alone how to use it. I've also had in some of the calls that we received, doctors tell me that they actually use the ABN form from day 1 for their adjustments let alone other services so that they don't have to bill Medicare. Is that even okay? That's a good point you bring up. It's a good understanding of the ABN. Let's start first with to make sure there's a good understanding, what does Medicare cover? Medicare only covers spinal manipulation which is 3 codes which there are 2000 CPT codes. That means Medicare doesn't cover 1997 services for chiropractors. What a lot of doctors do and it's allowed, you can take these Advance Beneficiary Notice at the beginning of care and have the patient sign where it says the services you receive here including exam, x-rays, therapies are not covered. That's completely acceptable to do so. My recommendation is to not use it from day 1 because truthfully, I think the ABN form is slightly confusing. My recommendation would be for a doctor to have a simple financial agreement for Medicare patient that explains the Medicare program such as you would do with any patient. It would explain that Medicare deductible is 166 that Medicare only covers spine manipulation and any other service you may receive is your responsibility. They should sign that day 1.
Dr. Hoffman:
Dr. Murkowski:
Dr. Hoffman:
Dr. Collins:
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