Subject: Untitled
Date: Sun, 21 Sep 1997 00:49:03 -0400
From: asperis@aol.com (Kirsten Ganavazos)
 

<<Questions to Calif. docs: 1. I'm signing up to accept Medicare...but 
am confused whether it's preferrable to be an assigned or unassigned 
provider? [if those are the correct terms? >>

Dear Doctor,

When you become a "PAR" provider, you are agreeing to accept Medicares 
"limiting charge". you can only charge the patient the balance of the 
limiting charge.

Example:

Charge: 98940 CMT Medicare Limiting Charge: $26.44

Medicare pays 80% of that: $21.15

You are only allowed the bill the patient for $5.29

If you are NON-PAR, then you are allowed to charge up to 115% of the 
limiting charge: 30.40. However, Medicare penalizes NON-PAR providers by 
taking 5% off the limiting charge. which brings it down to $25.18. You are 
then paid your 80% of that which is $20.09, but you are allowed to charge 
the patient $10.31.

Now the benefits to becoming PAR are that you are paid more from Medicare 
and your patients have less out-of pocket expenses. Another thing to consider,
would a medicare patient choose a PAR Provider over a NON-PAR Provider?  Are 
you in an area where the Medicare recipients would gladly pay you more 
out-of-pocket?

Medicare in PA  only covers up to 12 visits. In my opinion it is a terrible 
thing. Elderly can benefit greatly with the increased quality of life that 
chiropractic treatment provides. It is a sin that more treatment isn't covered.

In addition, Medicare will only reimburse for the CMT codes, 98940, 98941, 
and 98942 - Not 98943.  No therapy codes, no x-ray, no E/M, nada.

Hope this helps.

If I can be of assitance in anyway do not hesitate to ask.

Kirsten Ganavazos, HRS
asperis@aol.com