Medicare Demonstration Project Coseout Information

The Medicare Chiropractic Demonstration, as mandated by Section 651 of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA,) has been conducted in our state for the last two years and will end on March 31, 2007.

Brandeis University, under contract with CMS to conduct an independent evaluation of the Demonstration, is currently compiling data regarding patient survey responses, service utilization, and provider participation. Additionally, Brandeis is interviewing key players in the Demonstration to obtain their impressions.

An interim report of Brandeis’ findings will be sent to Congress in Spring, 2008. The final report is due in late 2009.

Medicare Demonstration Project Coseout Information

Change in Fee for 98943 for Med Demo Areas

Medicare Fee Schedule 2007

On Dec. 20, the President signed a bill which allows for the continuation of the therapy cap exception process. Here is a link to the MedLearn Matters article (MM5478) that discusses the changes for 2007: http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM5478.pdf

Federal Register/Vol. 70, No. 18/Friday, January 28, 2005/ Notices: Beginning April 2005 in New Mexico ~~ Medicare Demonstration Project: Demonstration of Coverage of Chiropractic Services Under Medicare
Important Links and Information Below

Links
Mailing Lists: http://www.cms.hhs.gov/mailinglists/

Medlearn Matters General Articles: http://www.cms.hhs.gov/medlearn/matters/default.asp?link=mma

2005 Articles: http://www.cms.hhs.gov/medlearn/matters/default.asp?link=2005

Medical Review Additional Documentation Requests (ADRs): http://www.cms.hhs.gov/medlearn/matters/mmarticles/2005/MM4022.pdf
Medicare Demo Project Updates

June 2006 NM Medicare Denial Management Workshops

VA/DOD Report by Dr. Michael E. Brown

Change in Demo Billing, April 26, 2006

May 16 & 17, 2006

ACA DEMO E_ALERT FEBRUARY 16, 2006

February 16, 2006, New Medlearn Article ~ Important Read ~ New Information!!

PAYMENT PROVISIONS IN THE ORIGINAL MEDICARE PROGRAM IMMEDIATELY AFFECTED BY THE DEFICIT REDUCTION ACT

2006 Chiropractic Medicare Fee Schedule & More

Fall Edition of Medicare Matters

Medicare Rules on Fraud & Abuse ~~ VERY IMPORTANT READ!!
(These Rules are also applicable to all insurance billing.)
Short Version
Long Version

For Immediate release: Pinnacle Business Solutions, Inc., forms to administer Public Programs for Arkansas Blue Cross and Blue Shield

Mainstreaming Chiropractic: The Miserable Medicare Model

Important Medicare Survey Coming soon to your Mailbox!

www.acatoday.com/demo

Medicare Hurricane Disaster Website Announcement ~ Hurricane Disaster Assistance Information from Medicare

Medicare & X-Ray Information Links
1) Medlearn Matters Article SE0614, Referral of Patients for X-Rays by Chiropractors:
2) Medicare Learning Network, same topic:
3) Under Resources section, see X-Rays:

Electronic Bill Exemption Information

LINK TO CMS APPEALS BROCHURE

MED DEMO BILLING DOs AND DON'Ts ~ A Must Read!!

"INCIDENT TO" RULES BACK IN EFFECT AS OF MONDAY, JULY 25, 2005

Subject: ACA SPECIAL ALERT: Incident To Regulations

FINAL RULING ON "INCIDENT TO" REGULATIONS FOR MED DEMO PROJECT

ACA Demo e-Alerts

Office of Inspector General released a report titled "Chiropractic Services in the Medicare Program: Payment Vulnerability Analysis."

American Chiropractic Association Issues Statement in Response To Inspector General’s Report

CMS Announces Plans for Transitioning to the National Provider Identifier (NPI) in the Fee-for Service Medicare Program

NM Medicare Demonstration Project Beneficiary Fact Sheet

NM Medicare Demonstration Project Beneficiary Fact Sheet in Spanish

CMS Chiropractic Demo Web Page

ACA Demo Web Page

Chiropractic Demonstration Invitation

CMS Web Based Training Flyer and Link

Comprehensive Error Rate Testing (CERT) Program

Medicare Demo New Information, May 13, 2005

Medicare National Provider Identifier (NPI) ~ Information ~ May 16, 2005
CMS NOTICES

CMS web site has been recently updated. Please use the links provided below for more detailed information.

Expansion of Coverage for Chiropractic Services Demonstration
Reference: Medlearn Matters Number: SE0514
Note: This article was revised on March 11 to make several changes, including adding zip codes for Illinois, deleting CPT code 97010, and advising chiropractors that they are subject to local coverage decisions (LCDs) and lab National Coverage Determinations (NCDs). Under a two-year demonstration project beginning April 1, 2005, doctors of chiropractic will be able to bill Medicare carriers for the Part B medical, radiology, clinical lab, and therapy services that you provide for your Medicare fee-for-service patients. These services must be billed separately from current services that are covered under Medicare. You must include a demonstration code for all demonstration claims. Beginning April 1, 2005, CMS is conducting a demonstration to evaluate the feasibility and advisability of expanding the coverage of diagnostic and other chiropractic services under Medicare. This demonstration is required by Section 651 of the Medicare Modernization Act of 2003 (MMA). There is no requirement to enroll in the demonstration in order to bill for the additional demonstration services. If you are a doctor of chiropractic providing services in the geographic areas of this demonstration, make certain that your billing offices are aware of this demonstration and the expanded coverage of chiropractic services that it allows.
http://www.oknmmedicare.com/provider/viewarticle.aspx?articleid=1574

Expansion of Coverage for Chiropractic Services Demonstration - Information Relevant to Outpatient Hospitals and Independent Clinical Laboratories
Reference: Medlearn Matters Number: SE0521
Under a two-year demonstration project beginning April 1, 2005, chiropractors are allowed to order laboratory tests. You will be reimbursed by Medicare for labs that are ordered by chiropractors who practice in the demonstration areas. Beginning April 1, 2005, CMS is conducting a demonstration to evaluate the feasibility and advisability of expanding the coverage of diagnostic and other chiropractic services under Medicare. This demonstration is required by Section 651 of the Medicare Modernization Act of 2003 (MMA). If you accept referrals from chiropractors in the geographic areas of this demonstration, make certain that your billing offices are aware of this demonstration and the ability to accept referrals for clinical laboratory services.
http://www.oknmmedicare.com/provider/viewarticle.aspx?articleid=1575

Expansion of Coverage for Chiropractic Services Demonstration - Information for Outpatient Hospitals and Radiologists
Reference: Medlearn Matters Number: SE0522
Under a two-year demonstration project beginning April 1, 2005, chiropractors are allowed to order x-rays, MRIs, and CT scans. You will be reimbursed by Medicare for radiology services that are ordered by chiropractors who practice in the demonstration areas. Beginning April 1, 2005, CMS is conducting a demonstration to evaluate the feasibility and advisability of expanding the coverage of diagnostic and other chiropractic services under Medicare. This demonstration is required by Section 651 of the Medicare Modernization Act of 2003 (MMA). If you accept referrals from chiropractors in the geographic areas of this demonstration, make certain that your billing offices are aware of this demonstration and the ability to accept referrals for x-rays, MRIs, and CT scans.
http://www.oknmmedicare.com/provider/viewarticle.aspx?articleid=1578

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