June 15, 2025 • 16 mins
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.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Dr. Michael Perusich (00:09):
Doctors, are you fully compliant and in
full understanding of Medicare?
Hi everybody.
Welcome to the KC Chiro Pulsepodcast, brought to you by Kats
Consultants and Chiro HealthUSA.
I'm Dr.
Michael Perusich and I'm joinedby my co-host Marisa Mateja.
Marisa.
Hi.
The confusion on Medicare.
Wow, that's real.
So we, it is real becausethere's part A, part B, part C,
(00:33):
part D.
Then it does, it gets reallyconfusing.
And so we see this a lot withdoctors.
That we speak with every day andwe just want to provide you guys
with just a little bit ofguidance and clarification
today.
Marisa, I'm just gonna shut uphere and let you go
Marisa Mateja (00:48):
ex.
That's exciting.
What we really see is, obviouslythere's part A, B, C, and D in
Medicare.
We all know that there'sdifferent parts in chiropractic.
We really just need to focus onthe middle two.
So part B and part C, C is ouradvantage, right?
The confusion.
It comes in not understandingthat there's a difference
(01:10):
between the two.
And many practices wanna lumpthe part B rules in with the
Part C rules or vice versa.
And I think that's where we seeso much confusion instead of
really thinking of them as twoseparate entities, which is
where sometimes in your mind youhave to compartmentalize.
(01:30):
And that's what I recommenddoing for Medicare is car.
Compartmentalize the fact thatpart B and part C separate those
two things.
Don't keep them linked underMedicare, because that's where
all the confusion,
Dr. Michael Perusich (01:45):
that's where the confusion comes.
Yeah.
'cause then you wanna apply yourtraditional Medicare rules to
it.
And.
B is not C and C is not B.
Are there some similarities?
Sometimes, yeah, but sometimesthere's some dramatic
differences between the two.
Marisa Mateja (02:01):
Yeah, and while they both usually have
chiropractic manipulationoffered under there, where we
get mixed up is now part Cbecause they are through private
insurance companies.
They sometimes offer morebenefits, and that's where the
confusion starts to come in.
(02:21):
Yeah, what I really see is somany offices just not verifying
benefits on advantage plans andwanting to just go with it's
Medicare.
And then they're getting trippedup on the rules.
They're getting tripped up onthe modifiers.
They're getting tripped up oneverything that belongs under
parties.
Dr. Michael Perusich (02:41):
Claims are getting denied.
Marisa Mateja (02:43):
Yeah, and some of these companies we're seeing
more and more, it requires somekind 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 mostcommon places that errors begin
is right, not having staffthat's spending the time to
(03:04):
actually find out what's acovered benefit under this plan.
And I always talk about theseplans.
They're no different than aperson going and buying a
general insurance policy.
And when they walk in, thesalesperson goes.
Which plan would you like?
Because there's a whole bunch ofdifferent ones.
You can pay this right, highpremium and get all the stuff
(03:28):
included, or you can pay thislow premium and you get some of
the basic.
And everything in between.
So it's, yep.
It's something that, is nodifferent than that.
So I think that's where theconfusion comes in is we want it
to be Medicare because we knowour Medicare rules and we know
Medicare doesn't cover exams orany kind of therapies or
acupuncture, all these things,right?
(03:50):
But under these Part C plans,there are plans out there
covering a lot more than justthe chiropractic manipulation.
And you have That's right.
High benefits.
Dr. Michael Perusich (04:02):
So I wanna pause here for just a second.
Before we dive in a little bitmore, I wanna pause and take a
break to hear word from oursponsors.
But when we come back, Marisa, Iwant to dive into okay, really
what's the skinny and the downlow on B and c and some of the
specifics.
Okay?
Okay.
We'll be right back.
(04:23):
All right, everybody, we areback.
This is the Casey Copul podcast.
We are talking about everybody'sfavorite subject, Medicare, and
the differences between Part Band part C.
And the differences can befairly dramatic.
There are some overlays,overlaps between the two, but
like I said before, part B isnot C, and part C is not B.
(04:46):
So you have to understand thedifference between the two.
And Marisa, you said somethingbefore the break that.
Something about verifyingbenefits.
Oh my
Marisa Mateja (04:54):
gosh.
I know.
Dr. Michael Perusich (04:55):
Novel idea.
Marisa Mateja (04:57):
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 tothe Advantage plans a lot of
times in practices because weare so used to the fact that
Advantage plans were, they usedto be similar to Medicare, with
the exception of what thepatient pays out of pocket.
So there might be copays andhigher deductibles or different
(05:21):
co-insurance and those kind ofthings.
But now we are layering in thefact that they may cover more.
And it's important that we'reverifying benefits so that we
know that.
So that's step one inunderstanding your advantage
plans.
The second part of this is the ABN form.
This is the other confusing partabout advantage plans.
(05:44):
Oh my gosh, they are not reallyMedicare.
Remember what I said earlier?
They're private insurancecompanies that are utilizing
some of, sorry to be in Part C.
It's through private insurancecompanies.
So what we need to verify firstis the benefits, but then we
need to know do they have an ABN like form?
(06:05):
It's not the A BN form becausethe A BN form is just for Part
B.
I know some of you just passedout.
The A BN form is just for PartB.
I'm gonna say it again.
Dr. Michael Perusich (06:16):
I heard the thuds hitting the floor.
Yeah,
Marisa Mateja (06:17):
so Part CS may have a form like the A BN.
If they don't, we recommendcreating your own so that you've
got something that you'reshowing to the patient to let
them know that maintenance careat this time may not be covered,
but.
Make sure that you verified yourbenefits because some of those
plans out there could covermaintenance care.
Dr. Michael Perusich (06:41):
Whoa, whoa.
Wait a minute.
Boom.
Marisa Mateja (06:44):
Exactly.
I think we all
Dr. Michael Perusich (06:45):
just exploded here for a second.
Marisa Mateja (06:47):
Yeah.
Dr. Michael Perusich (06:47):
Yeah, you're absolutely right.
Some of the advantage plans,some of the Cadillac Advantage
plans actually cover somemaintenance.
So Marisa, how do they find thatout?
Marisa Mateja (06:57):
They've gotta verify benefits.
They've got to look on theirinsurance company's websites.
They've got to read theinsurance policy on chiropractic
care that.
Can be listed many differentways on their website.
So you've gotta know yourinsurance companies and where
your benefits can be foundonline.
What I, what do I mean by that?
(07:17):
Some of them your medicares callit your local coverage
determinations, your LCDs, someof them just call it
chiropractic services.
Some of us are lumped underalternative medicine.
So there's like a PLE or the
Dr. Michael Perusich (07:30):
medical policy?
Marisa Mateja (07:32):
Yeah, there's a.
Plethora of different placesthat we could be located, right?
So you've gotta know yourinsurance companies and we
recommend printing out thatinformation, highlighting the
chiropractic section, laminatingit, having it close to you when
you're going over benefits ifyou need to.
But have that information in thepractice so that you know what
(07:52):
their policies are and things.
And then go ahead and verifythose benefits and make sure, so
we've got verified benefits,we've got the A BN.
And then the other thing that Iusually recommend is looking for
what modifiers that insurancecompany requires because there
are so many different so manydifferent modifiers out there
(08:15):
that some of these plansrequire.
Not all of them require the ATand the ga, like part B, some of
them require something else.
So you need to be up to date onwhat.
They require and I'd love to gointo those, but there's so many
different companies out therethat you just have to know what
your recommends.
(08:36):
So make sure that you're billingappropriately, you're, you've
got your modifiers on there,that you need all of those kind
of things.
And the last part is making surethat you understand and know if
you have to do any kind of priorauthorizations.
Some of these companies willonly authorize so many visits at
once and you have to make surethat you're doing the
(08:56):
appropriate steps for thatparticular insurance company.
Dr. Michael Perusic (09:01):
Absolutely.
That's another good stoppingpoint.
So we can take a quick breakhere.
But when we come back, I want totalk about just some of the
compliance issues aroundMedicare and then we'll clean
this up for everybody.
So hopefully everybody'senjoying this conversation.
We're talking about thedifferences between Medicare
Part B, which is the standardold good old fashioned Medicare
(09:21):
and Medicare Part C, which isnothing like in a lot of cases.
Part B.
So now that I set the hook forthat confusion, here's a word
from our sponsors, we'll beright back.
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Dr. Michael Perusich (10:45):
Okay, everybody, welcome back to the
KC Chiro Pulse podcast.
We're talking about someexciting stuff called Medicare
Part B and part C, and for thoseof you that are still awake,
Marisa, let's pull this all backtogether for everybody, and then
I wanna talk about some of thecompliance trip ups that people
get into.
Marisa Mateja (11:02):
Yeah.
Four steps, just making sureyou're verifying benefits, what
modifiers you need, if it needsprior authorization.
You wanna make sure that youknow the medical policies on
that plan that's where I wasgoing.
Those are the main things thatyou really want to make sure of
and just understand.
What are those rules?
And make sure you're followingthose rules.
And then on your end compliancewise, making sure your
(11:25):
documentation matches well, andthat you've got discharge
summaries and you've got thosethings when people move to
maintenance and you've got allthe 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 askfor records that you are
prepared and you have a strongnote to back up what you've done
(11:46):
in your practice.
Dr. Michael Perusich (11:48):
Yeah, remember that Medi Medicare
doesn't pay for continual care.
They pay for care that has aresolution point or a maximum
improvement point, and we allknow that as medically necessary
versus clinically appropriate.
So how do we prove medicalnecessity?
You have to do periodic examsonce in a while, putting that
(12:10):
paperwork back in front of thepatient, getting your outcome
assessment questionnaires filledout from the patient doing the
exam and proving that thepatient either still needs care
because they're responding, orit's time to move them over to
maintenance.
And I think that's one of thebiggest mistakes that doctors
make is they create these.
Arbitrary points of change wherethere's no exam, there's no
(12:34):
supporting documentation, andthings like changing an onset
date and a diagnosis without anexam and proof of that diagnosis
can be a real tripper for you.
So make sure you're goingthrough the steps, and I know
Medicare doesn't pay for theexams.
But that doesn't mean you, youshouldn't do them.
(12:55):
You should do them.
Your patients probably knowthat's not covered, especially
if you've done a good jobupfront with your financial
report of findings.
They will know that there arenon-covered expenses throughout
the treatment plan.
So just make sure that you'refollowing those steps.
Marisa Mateja (13:11):
Yeah.
And have a piece of paper thatoutlines what's covered in
what's not form.
Oh, I don't know.
It's called the no SurprisesAct.
You can use, oh, I've heard ofthat.
You can use those kind of toolsin your practice correctly by
showing people.
What it is that's covered andwhat's not covered.
Making sure they understandupfront what those things are,
and we highly recommend thatwe're not giving away care.
(13:32):
Make sure you're collecting forwhat you're doing.
Not only is that a good businessmove, but it's also keeping you
off the enticement list.
So make sure, yes, please makesure that you're, doing the
appropriate things.
And of course, if you need help,we're available.
Make sure that you tune in withus if you'd like.
Some help in those areas.
Dr. Michael Perusic (13:54):
Absolutely.
So Medicare really, I don't careif it's part B or Part C, it's
pretty straightforward.
If you just slow down longenough, verify, make sure you
look at those medical policiesor LCDs, however it's listed
tho, those are chocked full ofall kinds of great information
to help you, and it will makethe process so much smoother.
(14:14):
So make sure you're goingthrough the steps of doing your
exams, doing your PART.
Unless you have x-rays and justmaking sure that you're
following the steps and nottrying to shortcut what's the
risk if you're short cutting.
The risk is getting audited, andunfortunately, the fines can be
up to$15,000 per occurrence.
So if you tripped up 10 times onone patient, it could cost you
(14:37):
$150,000.
Nobody wants to face that.
Marisa Mateja (14:40):
No.
Dr. Michael Perusich (14:41):
Medicare's pretty straightforward.
So don't make it difficult bytrying to shortcut, by trying to
not verify benefits and thingsand be open and honest with your
patients about what that processis.
Marisa Mateja (14:53):
Absolutely.
Dr. Michael Perusich (14:54):
Marisa, anything else to add?
Marisa Mateja (14:55):
No, I think that's it.
If you have questions, perfect,feel free to reach out.
But touch base with us, justcompartmentalize that b and c
and make those two differententities so that helps you
understand a little bit moreabout those.
Dr. Michael Perusich (15:08):
I'm gonna throw one more thing in'cause I
just thought of it.
Remember doctors, the move tomaintenance is initiated by you,
the doctor, not your staff.
So make sure that you'reinitiating that move to
maintenance.
Alright everybody, thanks fortuning in.
We appreciate you tuning inevery week.
Please.
We're growing and it's becauseof you listeners out there.
So subscribe, share, and keeptuning in every week.
(15:30):
And be sure to go to katsconsultants.com and check out
all the great things that we'redoing to help.
Doctors like you have moreprofitable and more efficient
practices.
Marisa, thanks for being heretoday.
Marisa Mateja (15:42):
Thanks so much.
Dr. Michael Perusich (15:43):
Alright everybody.
From all of us at KatsConsultants, we will see you
soon.
Marisa Mateja (15:47):
See ya.
Kats Consultants (15:52):
Kats Chiropractic consultants, your
partner in chiropractic success.
We are dedicated with one-on-oneguidance to bring you all your
practice management needs.
Let's supercharge your practice.
Give us a call today.
Doctors, are you fully compliant and in
full understanding of Medicare?
Hi everybody.
Welcome to the KC Chiro Pulsepodcast, brought to you by Kats
Consultants and Chiro HealthUSA.
I'm Dr.
Michael Perusich and I'm joinedby my co-host Marisa Mateja.
Marisa.
Hi.
The confusion on Medicare.
Wow, that's real.
So we, it is real becausethere's part A, part B, part C,
(00:33):
part D.
Then it does, it gets reallyconfusing.
And so we see this a lot withdoctors.
That we speak with every day andwe just want to provide you guys
with just a little bit ofguidance and clarification
today.
Marisa, I'm just gonna shut uphere and let you go
Marisa Mateja (00:48):
ex.
That's exciting.
What we really see is, obviouslythere's part A, B, C, and D in
Medicare.
We all know that there'sdifferent parts in chiropractic.
We really just need to focus onthe middle two.
So part B and part C, C is ouradvantage, right?
The confusion.
It comes in not understandingthat there's a difference
(01:10):
between the two.
And many practices wanna lumpthe part B rules in with the
Part C rules or vice versa.
And I think that's where we seeso much confusion instead of
really thinking of them as twoseparate entities, which is
where sometimes in your mind youhave to compartmentalize.
(01:30):
And that's what I recommenddoing for Medicare is car.
Compartmentalize the fact thatpart B and part C separate those
two things.
Don't keep them linked underMedicare, because that's where
all the confusion,
Dr. Michael Perusich (01:45):
that's where the confusion comes.
Yeah.
'cause then you wanna apply yourtraditional Medicare rules to
it.
And.
B is not C and C is not B.
Are there some similarities?
Sometimes, yeah, but sometimesthere's some dramatic
differences between the two.
Marisa Mateja (02:01):
Yeah, and while they both usually have
chiropractic manipulationoffered under there, where we
get mixed up is now part Cbecause they are through private
insurance companies.
They sometimes offer morebenefits, and that's where the
confusion starts to come in.
(02:21):
Yeah, what I really see is somany offices just not verifying
benefits on advantage plans andwanting to just go with it's
Medicare.
And then they're getting trippedup on the rules.
They're getting tripped up onthe modifiers.
They're getting tripped up oneverything that belongs under
parties.
Dr. Michael Perusich (02:41):
Claims are getting denied.
Marisa Mateja (02:43):
Yeah, and some of these companies we're seeing
more and more, it requires somekind 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 mostcommon places that errors begin
is right, not having staffthat's spending the time to
(03:04):
actually find out what's acovered benefit under this plan.
And I always talk about theseplans.
They're no different than aperson going and buying a
general insurance policy.
And when they walk in, thesalesperson goes.
Which plan would you like?
Because there's a whole bunch ofdifferent ones.
You can pay this right, highpremium and get all the stuff
(03:28):
included, or you can pay thislow premium and you get some of
the basic.
And everything in between.
So it's, yep.
It's something that, is nodifferent than that.
So I think that's where theconfusion comes in is we want it
to be Medicare because we knowour Medicare rules and we know
Medicare doesn't cover exams orany kind of therapies or
acupuncture, all these things,right?
(03:50):
But under these Part C plans,there are plans out there
covering a lot more than justthe chiropractic manipulation.
And you have That's right.
High benefits.
Dr. Michael Perusich (04:02):
So I wanna pause here for just a second.
Before we dive in a little bitmore, I wanna pause and take a
break to hear word from oursponsors.
But when we come back, Marisa, Iwant to dive into okay, really
what's the skinny and the downlow on B and c and some of the
specifics.
Okay?
Okay.
We'll be right back.
(04:23):
All right, everybody, we areback.
This is the Casey Copul podcast.
We are talking about everybody'sfavorite subject, Medicare, and
the differences between Part Band part C.
And the differences can befairly dramatic.
There are some overlays,overlaps between the two, but
like I said before, part B isnot C, and part C is not B.
(04:46):
So you have to understand thedifference between the two.
And Marisa, you said somethingbefore the break that.
Something about verifyingbenefits.
Oh my
Marisa Mateja (04:54):
gosh.
I know.
Dr. Michael Perusich (04:55):
Novel idea.
Marisa Mateja (04:57):
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 tothe Advantage plans a lot of
times in practices because weare so used to the fact that
Advantage plans were, they usedto be similar to Medicare, with
the exception of what thepatient pays out of pocket.
So there might be copays andhigher deductibles or different
(05:21):
co-insurance and those kind ofthings.
But now we are layering in thefact that they may cover more.
And it's important that we'reverifying benefits so that we
know that.
So that's step one inunderstanding your advantage
plans.
The second part of this is the ABN form.
This is the other confusing partabout advantage plans.
(05:44):
Oh my gosh, they are not reallyMedicare.
Remember what I said earlier?
They're private insurancecompanies that are utilizing
some of, sorry to be in Part C.
It's through private insurancecompanies.
So what we need to verify firstis the benefits, but then we
need to know do they have an ABN like form?
(06:05):
It's not the A BN form becausethe A BN form is just for Part
B.
I know some of you just passedout.
The A BN form is just for PartB.
I'm gonna say it again.
Dr. Michael Perusich (06:16):
I heard the thuds hitting the floor.
Yeah,
Marisa Mateja (06:17):
so Part CS may have a form like the A BN.
If they don't, we recommendcreating your own so that you've
got something that you'reshowing to the patient to let
them know that maintenance careat this time may not be covered,
but.
Make sure that you verified yourbenefits because some of those
plans out there could covermaintenance care.
Dr. Michael Perusich (06:41):
Whoa, whoa.
Wait a minute.
Boom.
Marisa Mateja (06:44):
Exactly.
I think we all
Dr. Michael Perusich (06:45):
just exploded here for a second.
Marisa Mateja (06:47):
Yeah.
Dr. Michael Perusich (06:47):
Yeah, you're absolutely right.
Some of the advantage plans,some of the Cadillac Advantage
plans actually cover somemaintenance.
So Marisa, how do they find thatout?
Marisa Mateja (06:57):
They've gotta verify benefits.
They've got to look on theirinsurance company's websites.
They've got to read theinsurance policy on chiropractic
care that.
Can be listed many differentways on their website.
So you've gotta know yourinsurance companies and where
your benefits can be foundonline.
What I, what do I mean by that?
(07:17):
Some of them your medicares callit your local coverage
determinations, your LCDs, someof them just call it
chiropractic services.
Some of us are lumped underalternative medicine.
So there's like a PLE or the
Dr. Michael Perusich (07:30):
medical policy?
Marisa Mateja (07:32):
Yeah, there's a.
Plethora of different placesthat we could be located, right?
So you've gotta know yourinsurance companies and we
recommend printing out thatinformation, highlighting the
chiropractic section, laminatingit, having it close to you when
you're going over benefits ifyou need to.
But have that information in thepractice so that you know what
(07:52):
their policies are and things.
And then go ahead and verifythose benefits and make sure, so
we've got verified benefits,we've got the A BN.
And then the other thing that Iusually recommend is looking for
what modifiers that insurancecompany requires because there
are so many different so manydifferent modifiers out there
(08:15):
that some of these plansrequire.
Not all of them require the ATand the ga, like part B, some of
them require something else.
So you need to be up to date onwhat.
They require and I'd love to gointo those, but there's so many
different companies out therethat you just have to know what
your recommends.
(08:36):
So make sure that you're billingappropriately, you're, you've
got your modifiers on there,that you need all of those kind
of things.
And the last part is making surethat you understand and know if
you have to do any kind of priorauthorizations.
Some of these companies willonly authorize so many visits at
once and you have to make surethat you're doing the
(08:56):
appropriate steps for thatparticular insurance company.
Dr. Michael Perusic (09:01):
Absolutely.
That's another good stoppingpoint.
So we can take a quick breakhere.
But when we come back, I want totalk about just some of the
compliance issues aroundMedicare and then we'll clean
this up for everybody.
So hopefully everybody'senjoying this conversation.
We're talking about thedifferences between Medicare
Part B, which is the standardold good old fashioned Medicare
(09:21):
and Medicare Part C, which isnothing like in a lot of cases.
Part B.
So now that I set the hook forthat confusion, here's a word
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(09:58):
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Dr. Michael Perusich (10:45):
Okay, everybody, welcome back to the
KC Chiro Pulse podcast.
We're talking about someexciting stuff called Medicare
Part B and part C, and for thoseof you that are still awake,
Marisa, let's pull this all backtogether for everybody, and then
I wanna talk about some of thecompliance trip ups that people
get into.
Marisa Mateja (11:02):
Yeah.
Four steps, just making sureyou're verifying benefits, what
modifiers you need, if it needsprior authorization.
You wanna make sure that youknow the medical policies on
that plan that's where I wasgoing.
Those are the main things thatyou really want to make sure of
and just understand.
What are those rules?
And make sure you're followingthose rules.
And then on your end compliancewise, making sure your
(11:25):
documentation matches well, andthat you've got discharge
summaries and you've got thosethings when people move to
maintenance and you've got allthe 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 askfor records that you are
prepared and you have a strongnote to back up what you've done
(11:46):
in your practice.
Dr. Michael Perusich (11:48):
Yeah, remember that Medi Medicare
doesn't pay for continual care.
They pay for care that has aresolution point or a maximum
improvement point, and we allknow that as medically necessary
versus clinically appropriate.
So how do we prove medicalnecessity?
You have to do periodic examsonce in a while, putting that
(12:10):
paperwork back in front of thepatient, getting your outcome
assessment questionnaires filledout from the patient doing the
exam and proving that thepatient either still needs care
because they're responding, orit's time to move them over to
maintenance.
And I think that's one of thebiggest mistakes that doctors
make is they create these.
Arbitrary points of change wherethere's no exam, there's no
(12:34):
supporting documentation, andthings like changing an onset
date and a diagnosis without anexam and proof of that diagnosis
can be a real tripper for you.
So make sure you're goingthrough the steps, and I know
Medicare doesn't pay for theexams.
But that doesn't mean you, youshouldn't do them.
(12:55):
You should do them.
Your patients probably knowthat's not covered, especially
if you've done a good jobupfront with your financial
report of findings.
They will know that there arenon-covered expenses throughout
the treatment plan.
So just make sure that you'refollowing those steps.
Marisa Mateja (13:11):
Yeah.
And have a piece of paper thatoutlines what's covered in
what's not form.
Oh, I don't know.
It's called the no SurprisesAct.
You can use, oh, I've heard ofthat.
You can use those kind of toolsin your practice correctly by
showing people.
What it is that's covered andwhat's not covered.
Making sure they understandupfront what those things are,
and we highly recommend thatwe're not giving away care.
(13:32):
Make sure you're collecting forwhat you're doing.
Not only is that a good businessmove, but it's also keeping you
off the enticement list.
So make sure, yes, please makesure that you're, doing the
appropriate things.
And of course, if you need help,we're available.
Make sure that you tune in withus if you'd like.
Some help in those areas.
Dr. Michael Perusic (13:54):
Absolutely.
So Medicare really, I don't careif it's part B or Part C, it's
pretty straightforward.
If you just slow down longenough, verify, make sure you
look at those medical policiesor LCDs, however it's listed
tho, those are chocked full ofall kinds of great information
to help you, and it will makethe process so much smoother.
(14:14):
So make sure you're goingthrough the steps of doing your
exams, doing your PART.
Unless you have x-rays and justmaking sure that you're
following the steps and nottrying to shortcut what's the
risk if you're short cutting.
The risk is getting audited, andunfortunately, the fines can be
up to$15,000 per occurrence.
So if you tripped up 10 times onone patient, it could cost you
(14:37):
$150,000.
Nobody wants to face that.
Marisa Mateja (14:40):
No.
Dr. Michael Perusich (14:41):
Medicare's pretty straightforward.
So don't make it difficult bytrying to shortcut, by trying to
not verify benefits and thingsand be open and honest with your
patients about what that processis.
Marisa Mateja (14:53):
Absolutely.
Dr. Michael Perusich (14:54):
Marisa, anything else to add?
Marisa Mateja (14:55):
No, I think that's it.
If you have questions, perfect,feel free to reach out.
But touch base with us, justcompartmentalize that b and c
and make those two differententities so that helps you
understand a little bit moreabout those.
Dr. Michael Perusich (15:08):
I'm gonna throw one more thing in'cause I
just thought of it.
Remember doctors, the move tomaintenance is initiated by you,
the doctor, not your staff.
So make sure that you'reinitiating that move to
maintenance.
Alright everybody, thanks fortuning in.
We appreciate you tuning inevery week.
Please.
We're growing and it's becauseof you listeners out there.
So subscribe, share, and keeptuning in every week.
(15:30):
And be sure to go to katsconsultants.com and check out
all the great things that we'redoing to help.
Doctors like you have moreprofitable and more efficient
practices.
Marisa, thanks for being heretoday.
Marisa Mateja (15:42):
Thanks so much.
Dr. Michael Perusich (15:43):
Alright everybody.
From all of us at KatsConsultants, we will see you
soon.
Marisa Mateja (15:47):
See ya.
Kats Consultants (15:52):
Kats Chiropractic consultants, your
partner in chiropractic success.
We are dedicated with one-on-oneguidance to bring you all your
practice management needs.
Let's supercharge your practice.
Give us a call today.
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