Chiropractic Assistants

Welcome to the Chiropractic Assistants page of the Massachusetts Chiropractic Society. This page is an informational resource only. Specific questions or concerns regarding a specific carrier should be directed to the provider services department of that particular carrier. The MCS does not speak for nor represent any insurance carrier or third party.

Links and descriptions are provided as a resource. CPT and ICD codes and related terminology are owned and copyrighted the AMA. Links and resources outlined in this site are not a direct or implied endorsement. The information on this page is intended for MCS member offices only. More information and resources can be found on the Member Side of masschiro.org.

Every CA that bills should stay current on coding and billing practices. The 2008 ChiroCode Deskbook is available at a discounted rate to MCS member offices. Logon to the member side for more information and to order your copy: MEMBER LOG IN

Does your Doctor and Facility have a NPI number yet?

Learn more about the National Provider Identification Number click the following link:
NPI Information

EVERY provider needs to obtain a NPI number: Click Here to Apply Online

MEDICARE INFORMATION:

• The Local Carrier for the Medicare program is the National Heritage Insurance Company. Their website for resources is: http://www.medicarenhic.com
• The "Introduction to Medicare Billing Guide" can be found at: http://www.medicarenhic.com/providers/pubs/introguide.pdf
• The NHIC Specialty Page for Chiropractic Services is: http://www.medicarenhic.com/ne_prov/specialty_chiro.shtml
• The Local Coverage Determination or LCD is a resource to assist providers in documentation and coverage limitations. The LCD can be found at the following link. Remember to scroll down once you click the link to accept the terms of the CMS site: http://www.cms.hhs.gov/mcd/viewlcd.asp?lcd_id=3172&lcd_version=50&show=all
• The Chiropractic Billing Guide can be found at: http://www.medicarenhic.com/providers/pubs/chiroguide.pdf
• The 2008 Revised Fee Schedule: http://www.masschiro.org/upload/news/57_0.pdf
• The Medicare Advanced Beneficiary Notification or ABN is used to notify Medicare Beneficiaries in advance that the Chiropractic Manipulative Therapy service (98940, 98941, 98942) is likely not going to be covered. More information on the ABN and how to use it can be found at: http://www.medicarenhic.com/providers/billing/abn.htm
• The ABN form itself can be found at: http://www.cms.hhs.gov/BNI/Downloads/CMSR131G.pdf
• Updated MedLearn Matters Article on the use of the AT modifier can be found at: http://www.cms.hhs.gov/MedlearnMattersArticles/downloads/MM3449.pdf
• The Notice of Exclusion from Medicare Benefits is used to notify Medicare Beneficiaries of those services that are statutorily not a covered service. In Massachusetts, for chiropractic, all services except the CMT codes (98940, 98941, 98942) are not covered under the Medicare Program.  In advance of any services other than the Chiropactic Manipulative Therapy, e.g. Exams, X-Rays, Modalities, Therapies, etc., a completed NEMB would be presented to the patient for review. Although there is no space for patient signature it may be prudent to have the patient sign the NEMB once reviewed and understood and a copy kept in their chart. Although the NEMB is not a legal document it can assist in clearing up any confusion for services not covered by Medicare. The NEMB can be found at: http://www.cms.hhs.gov/BNI/Downloads/CMS20007English.pdf
• More on the Appeals or redetermination process for Medicare Claims can be found at: http://www.medicarenhic.com/providers/articles/appealsprocess2007_0207.htm
• The Medicare Re-Determination Form can be found at: http://www.cms.hhs.gov/cmsforms/downloads/cms20027.pdf

WORKERS COMPENSATION INFORMATION:

• The Massachusetts Department of Industrial Accidents Home Page can be found at: http://www.mass.gov/dia
• The Form 101 is used to report the initial injury and is filed by the Employer. Obtaining this form from your patient initially can assist your billing specialist to verify:
1. The Patient is employed by the Employer reported at intake
2. The Patient's injuries were reported to the employer
3. The Date of Injury is accurate
4. The Insurance Carrier information (item 16 & 17)
5. Mechanism of Injury
• The Employee has the right to a copy of the Form 101 filed by the employer.
• A blank Form 101 can be found at: http://www.mass.gov/dia/DESKSCAN/101.PDF
• Utilization Review is a requirement under Workers Compensation Law. Utilization Review Agents have a certain timeline to follow when a provider requests review. CMR 6.04 (4)(b) says, "Notification of all adverse determinations by the utilization review agent shall be communicated to the provider of record and the injured employee or other appropriate individual in writing. For prospective review, notice must occur within two business days of the receipt of the request for determination and the receipt of all information necessary to complete the review. For concurrent review, the notification should be within one day prior to implementation (i.e., discharge) and for retrospective review, the notification should be within ten days of the adverse determination" The Full CMR 6.04 can be found at: http://www.mass.gov/dia/CMR/CMR6.00/604.htm
• The Department of Industrial Accidents provides a form for providers in the event a complaint to the DIA is needed. This form can be found at: http://www.mass.gov/dia/DESKSCAN/133A2.pdf
• Guidelines for treatment are a part of the Workers Compensation Program. The Health Care Services Board (HCSB) oversees and develops the guidelines for treatment of injured employees. In general there are four guidelines Chiropractors use as guidelines for treatment of injured workers.
• Guideline Number 20, "Diagnosis and Treatment of Neck and Back (Spinal) Injuries - Conservative Outpatient Treatment - Up to 6 Weeks from Date of Injury" can be found at: http://www.mass.gov/dia/hcsb/tg20.pdf
• Guideline Number 21, "Diagnosis and Treatment of Neck and Back (Spinal) Injuries - Conservative Outpatient Treatment - From 7 to 12 Weeks from Date of Injury" can be found at: http://www.mass.gov/dia/hcsb/tg21.pdf
• Guideline Number 26, "Chronic Neuromusculo-Skeletal Injury" can be found at: http://www.mass.gov/dia/hcsb/tg26.pdf
• Guideline Number 27, "Chronic Pain Syndrome" can be found at: http://www.mass.gov/dia/hcsb/tg27.pdf
• The Full categories of treatment guidelines can be found at: http://www.mass.gov/dia/hcsb/treatguides.htm
• The Department of Industrial Accidents provides a form in the event an Insurance Carrier cannot be identified. This form has instructions on completion and submission and can be found at: http://www.mass.gov/dia/DESKSCAN/Insurance-Inquiry.pdf

PERSONAL INJURY PROTECTION / AUTO

• Log into the Member Side of MassChiro.org. Once Logged in click on Claims Specialists under resources (on the Left Margin): http://www.masschiro.org/MemberLogin.php

Blue Cross & Blue Shield of Massachusetts

Tufts Health Plan:

Chiropractic Services Billing Guidelines: