Kats Chiropractic Consultants CHIROpulse

218 Let’s Clear the Air on Medicare!

• Marisa Mateja

Share episode

Welcome to the KC CHIROpulse Podcast.  

This week’s topic:  Let’s Clear the Air on Medicare!

The KC CHIROpulse Podcast is designed for Chiropractic professionals ready to elevate their practice to new heights.  This week, the show is hosted by Kats Consultants’ coaches Dr Michael Perusich and Marisa Mateja, seasoned experts in Chiropractic business management.  This podcast provides invaluable insights and actionable strategies to help you create a flourishing and sustainable Chiropractic business.

In this episode, we discuss:

  • How misunderstanding the Medicare rules can get you in trouble
  • The differences between Part B and Part C Medicare
  • Why verifying benefits is so important
  • How the LCD is your key to successful billing
  • …and so much more…

In each episode of KC CHIROpulse, we delve into crucial aspects of building a successful Chiropractic practice, covering topics such as establishing a strong foundation, adopting a patient-centric approach, mastering marketing techniques, achieving financial fitness, fostering effective team building and leadership, integrating technology and innovation, and navigating common challenges in the field.

Whether you're a seasoned chiropractor or just starting your practice, the KC CHIROpulse Podcast offers a wealth of knowledge and personalized practical advice to help you navigate the intricate world of Chiropractic business. Join us on this journey as we explore proven strategies, share success stories, and connect with industry experts to empower you in your pursuit of building a thriving Chiropractic practice.

Don't miss out on the latest insights and expert guidance. Subscribe now and unlock the secrets to taking your Chiropractic practice to the next level. Your success is our priority at Kats Chiropractic Business Advisors.

DISCLAIMER:  The information presented in this broadcast is for educational purposes only and is not intended to offer legal, investment, accounting, or medical advice, and represents the opinions of the speakers.  Seek the consultation of a professional for advice in those areas. And remember…your results using this information may be different than described.


Be sure to SUBSCRIBE to the Kats Consultants CHIROPulse Podcast
When you are ready we can help.


KC CHIROpulse Podcast. Helping Chiropractors keep their pulse on success. Thanks for listening.



Dr. Michael Perusich:

Doctors, are you fully compliant and in full understanding of Medicare? Hi everybody. Welcome to the KC Chiro Pulse podcast, brought to you by Kats Consultants and Chiro Health USA. I'm Dr. Michael Perusich and I'm joined by my co-host Marisa Mateja. Marisa. Hi. The confusion on Medicare. Wow, that's real. So we, it is real because there's part A, part B, part C, part D. Then it does, it gets really confusing. And so we see this a lot with doctors. That we speak with every day and we just want to provide you guys with just a little bit of guidance and clarification today. Marisa, I'm just gonna shut up here and let you go

Marisa Mateja:

ex. That's exciting. What we really see is, obviously there's part A, B, C, and D in Medicare. We all know that there's different parts in chiropractic. We really just need to focus on the middle two. So part B and part C, C is our advantage, right? The confusion. It comes in not understanding that there's a difference between the two. And many practices wanna lump the part B rules in with the Part C rules or vice versa. And I think that's where we see so much confusion instead of really thinking of them as two separate entities, which is where sometimes in your mind you have to compartmentalize. And that's what I recommend doing for Medicare is car. Compartmentalize the fact that part B and part C separate those two things. Don't keep them linked under Medicare, because that's where all the confusion,

Dr. Michael Perusich:

that's where the confusion comes. Yeah.'cause then you wanna apply your traditional Medicare rules to it. And. B is not C and C is not B. Are there some similarities? Sometimes, yeah, but sometimes there's some dramatic differences between the two.

Marisa Mateja:

Yeah, and while they both usually have chiropractic manipulation offered under there, where we get mixed up is now part C because they are through private insurance companies. They sometimes offer more benefits, and that's where the confusion starts to come in. Yeah, what I really see is so many offices just not verifying benefits on advantage plans and wanting to just go with it's Medicare. And then they're getting tripped up on the rules. They're getting tripped up on the modifiers. They're getting tripped up on everything that belongs under parties.

Dr. Michael Perusich:

Claims are getting denied.

Marisa Mateja:

Yeah, and some of these companies we're seeing more and more, it requires some kind of prior authorization, and so you have to. Verify benefits on Part Cs. I cannot stress that enough. I think that's one of the most common places that errors begin is right, not having staff that's spending the time to actually find out what's a covered benefit under this plan. And I always talk about these plans. They're no different than a person going and buying a general insurance policy. And when they walk in, the salesperson goes. Which plan would you like? Because there's a whole bunch of different ones. You can pay this right, high premium and get all the stuff included, or you can pay this low premium and you get some of the basic. And everything in between. So it's, yep. It's something that, is no different than that. So I think that's where the confusion comes in is we want it to be Medicare because we know our Medicare rules and we know Medicare doesn't cover exams or any kind of therapies or acupuncture, all these things, right? But under these Part C plans, there are plans out there covering a lot more than just the chiropractic manipulation. And you have That's right. High benefits.

Dr. Michael Perusich:

So I wanna pause here for just a second. Before we dive in a little bit more, I wanna pause and take a break to hear word from our sponsors. But when we come back, Marisa, I want to dive into okay, really what's the skinny and the down low on B and c and some of the specifics. Okay? Okay. We'll be right back. All right, everybody, we are back. This is the Casey Copul podcast. We are talking about everybody's favorite subject, Medicare, and the differences between Part B and part C. And the differences can be fairly dramatic. There are some overlays, overlaps between the two, but like I said before, part B is not C, and part C is not B. So you have to understand the difference between the two. And Marisa, you said something before the break that. Something about verifying benefits. Oh my

Marisa Mateja:

gosh. I know.

Dr. Michael Perusich:

Novel idea.

Marisa Mateja:

It's such a, it's such a thing. It's new to everybody, right? No, it's not. It's not new, but it's new to the Advantage plans a lot of times in practices because we are so used to the fact that Advantage plans were, they used to be similar to Medicare, with the exception of what the patient pays out of pocket. So there might be copays and higher deductibles or different co-insurance and those kind of things. But now we are layering in the fact that they may cover more. And it's important that we're verifying benefits so that we know that. So that's step one in understanding your advantage plans. The second part of this is the A BN form. This is the other confusing part about advantage plans. Oh my gosh, they are not really Medicare. Remember what I said earlier? They're private insurance companies that are utilizing some of, sorry to be in Part C. It's through private insurance companies. So what we need to verify first is the benefits, but then we need to know do they have an A BN like form? It's not the A BN form because the A BN form is just for Part B. I know some of you just passed out. The A BN form is just for Part B. I'm gonna say it again.

Dr. Michael Perusich:

I heard the thuds hitting the floor. Yeah,

Marisa Mateja:

so Part CS may have a form like the A BN. If they don't, we recommend creating your own so that you've got something that you're showing to the patient to let them know that maintenance care at this time may not be covered, but. Make sure that you verified your benefits because some of those plans out there could cover maintenance care.

Dr. Michael Perusich:

Whoa, whoa. Wait a minute. Boom.

Marisa Mateja:

Exactly. I think we all

Dr. Michael Perusich:

just exploded here for a second.

Marisa Mateja:

Yeah.

Dr. Michael Perusich:

Yeah, you're absolutely right. Some of the advantage plans, some of the Cadillac Advantage plans actually cover some maintenance. So Marisa, how do they find that out?

Marisa Mateja:

They've gotta verify benefits. They've got to look on their insurance company's websites. They've got to read the insurance policy on chiropractic care that. Can be listed many different ways on their website. So you've gotta know your insurance companies and where your benefits can be found online. What I, what do I mean by that? Some of them your medicares call it your local coverage determinations, your LCDs, some of them just call it chiropractic services. Some of us are lumped under alternative medicine. So there's like a PLE or the

Dr. Michael Perusich:

medical policy?

Marisa Mateja:

Yeah, there's a. Plethora of different places that we could be located, right? So you've gotta know your insurance companies and we recommend printing out that information, highlighting the chiropractic section, laminating it, having it close to you when you're going over benefits if you need to. But have that information in the practice so that you know what their policies are and things. And then go ahead and verify those benefits and make sure, so we've got verified benefits, we've got the A BN. And then the other thing that I usually recommend is looking for what modifiers that insurance company requires because there are so many different so many different modifiers out there that some of these plans require. Not all of them require the AT and the ga, like part B, some of them require something else. So you need to be up to date on what. They require and I'd love to go into those, but there's so many different companies out there that you just have to know what your recommends. So make sure that you're billing appropriately, you're, you've got your modifiers on there, that you need all of those kind of things. And the last part is making sure that you understand and know if you have to do any kind of prior authorizations. Some of these companies will only authorize so many visits at once and you have to make sure that you're doing the appropriate steps for that particular insurance company.

Dr. Michael Perusich:

Absolutely. That's another good stopping point. So we can take a quick break here. But when we come back, I want to talk about just some of the compliance issues around Medicare and then we'll clean this up for everybody. So hopefully everybody's enjoying this conversation. We're talking about the differences between Medicare Part B, which is the standard old good old fashioned Medicare and Medicare Part C, which is nothing like in a lot of cases. Part B. So now that I set the hook for that confusion, here's a word from our sponsors, we'll be right back.

Chiro Heatlh USA:

In today's economy, every dollar counts. Families are facing tough choices, having to reconsider what was once essential to them, but close to healthcare, no one should have to compromise on their wellbeing because of financial constraints. That's where Chiro, health, USA steps in the solution for your practice. We understand the financial pressures families are under. Whether they're insured on Medicare or paying out of pocket for treatment. By offering discounts on care, you can ensure that your patients can still afford the treatment they need. At Chiro Health USA, we're committed to making sure no family has to sacrifice their health due to financial hardship. We will work with you to create a game plan that keeps your waiting room full and your practice thriving. And here's the best part, offering affordable care not only benefits your patients, but also positively impacts your bottom line. So why wait? Join Chiro Health USA Today and join the ranks of the most successful practices because when you put your patients first, everyone wins.

Dr. Michael Perusich:

Okay, everybody, welcome back to the KC Chiro Pulse podcast. We're talking about some exciting stuff called Medicare Part B and part C, and for those of you that are still awake, Marisa, let's pull this all back together for everybody, and then I wanna talk about some of the compliance trip ups that people get into.

Marisa Mateja:

Yeah. Four steps, just making sure you're verifying benefits, what modifiers you need, if it needs prior authorization. You wanna make sure that you know the medical policies on that plan that's where I was going. Those are the main things that you really want to make sure of and just understand. What are those rules? And make sure you're following those rules. And then on your end compliance wise, making sure your documentation matches well, and that you've got discharge summaries and you've got those things when people move to maintenance and you've got all the stuff. And I'll let you dive into that, all the stuff that you need in your notes to make sure that. If you get audited, if they ask for records that you are prepared and you have a strong note to back up what you've done in your practice.

Dr. Michael Perusich:

Yeah, remember that Medi Medicare doesn't pay for continual care. They pay for care that has a resolution point or a maximum improvement point, and we all know that as medically necessary versus clinically appropriate. So how do we prove medical necessity? You have to do periodic exams once in a while, putting that paperwork back in front of the patient, getting your outcome assessment questionnaires filled out from the patient doing the exam and proving that the patient either still needs care because they're responding, or it's time to move them over to maintenance. And I think that's one of the biggest mistakes that doctors make is they create these. Arbitrary points of change where there's no exam, there's no supporting documentation, and things like changing an onset date and a diagnosis without an exam and proof of that diagnosis can be a real tripper for you. So make sure you're going through the steps, and I know Medicare doesn't pay for the exams. But that doesn't mean you, you shouldn't do them. You should do them. Your patients probably know that's not covered, especially if you've done a good job upfront with your financial report of findings. They will know that there are non-covered expenses throughout the treatment plan. So just make sure that you're following those steps.

Marisa Mateja:

Yeah. And have a piece of paper that outlines what's covered in what's not form. Oh, I don't know. It's called the no Surprises Act. You can use, oh, I've heard of that. You can use those kind of tools in your practice correctly by showing people. What it is that's covered and what's not covered. Making sure they understand upfront what those things are, and we highly recommend that we're not giving away care. Make sure you're collecting for what you're doing. Not only is that a good business move, but it's also keeping you off the enticement list. So make sure, yes, please make sure that you're, doing the appropriate things. And of course, if you need help, we're available. Make sure that you tune in with us if you'd like. Some help in those areas.

Dr. Michael Perusich:

Absolutely. So Medicare really, I don't care if it's part B or Part C, it's pretty straightforward. If you just slow down long enough, verify, make sure you look at those medical policies or LCDs, however it's listed tho, those are chocked full of all kinds of great information to help you, and it will make the process so much smoother. So make sure you're going through the steps of doing your exams, doing your PART. Unless you have x-rays and just making sure that you're following the steps and not trying to shortcut what's the risk if you're short cutting. The risk is getting audited, and unfortunately, the fines can be up to$15,000 per occurrence. So if you tripped up 10 times on one patient, it could cost you$150,000. Nobody wants to face that.

Marisa Mateja:

No.

Dr. Michael Perusich:

Medicare's pretty straightforward. So don't make it difficult by trying to shortcut, by trying to not verify benefits and things and be open and honest with your patients about what that process is.

Marisa Mateja:

Absolutely.

Dr. Michael Perusich:

Marisa, anything else to add?

Marisa Mateja:

No, I think that's it. If you have questions, perfect, feel free to reach out. But touch base with us, just compartmentalize that b and c and make those two different entities so that helps you understand a little bit more about those.

Dr. Michael Perusich:

I'm gonna throw one more thing in'cause I just thought of it. Remember doctors, the move to maintenance is initiated by you, the doctor, not your staff. So make sure that you're initiating that move to maintenance. Alright everybody, thanks for tuning in. We appreciate you tuning in every week. Please. We're growing and it's because of you listeners out there. So subscribe, share, and keep tuning in every week. And be sure to go to kats consultants.com and check out all the great things that we're doing to help. Doctors like you have more profitable and more efficient practices. Marisa, thanks for being here today.

Marisa Mateja:

Thanks so much.

Dr. Michael Perusich:

Alright everybody. From all of us at Kats Consultants, we will see you soon.

Marisa Mateja:

See ya.

Kats Consultants:

Kats Chiropractic consultants, your partner in chiropractic success. We are dedicated with one-on-one guidance to bring you all your practice management needs. Let's supercharge your practice. Give us a call today.