NEW YORK STATE MEDICAID PROGRAM CHIROPRACTOR MANUAL POLICY GUIDELINE - PDF document

NEW YORK STATE MEDICAID PROGRAM CHIROPRACTOR MANUAL POLICY GUIDELINES Chiropractor Manual Policy Guidelines Version 2007 – 1 November 1, 2007 SECTION I – REQUIREMENTS FOR PARTICIPATION IN MEDICAID........................................................ROVIDE AREIMITED HIROPRACTIC ERVICE OVERAGEEDICAID NROLLMENTSECTION II – CHIROPRACTIC SERVICES.............................................................................................COPE OF ERVICESSECTION III – BASIS OF PAYMENT FOR SERVICES PROVID

ED................................................................OVERAGE OF EDICARE OINSURANCE AND EDUCTIBLES FOR HIROPRACTORSDENTIFICATION OF QMBIMITED AYMENT OVERAGESECTION IV – ORDERING SERVICES.................................................................................................SECTION V – DEFINITIONS........................................................................................................QMB Chiropractor Manual Policy Guidelines Version 2007 – 1 November 1, 2007 Who May Provid

e Cares are established by the New York State (NYSED), and can be found at: http://www.op.nysed.gov/article132.htm Medicare requirements, must also be met. Medicareservices to treatmentthe spine to correct a subluxation The New York State Medicaid Program will only reimburse an enrolled surance, as appropriate, when Medicare approves the procedure. therapeutic service provided by a chiropractor. will not be an X-ray to determine or to interpreted by an appropriate Medicaid enrolled provider, Medicare deductible and coinsu

rance for the X-ray may al Chiropractor Manual Policy Guidelines Version 2007 – 1 November 1, 2007 Beneficiary coinsurance and deductible paymententitled to bill Medicare for chiropractic services to QMBs. Confirmation of Medicare requirements will be satisfied initially by submission of a evidence of Medicare participation will be saLicensure will be confirmed independently. Disqualification from Medicare participation shall constitute a disqualification from chiropractor from billing Medicaid. Chiropractor Manual

Policy Guidelines Version 2007 – 1 November 1, 2007 Section II – Chiropractic ServicesThe New York State Medicaid Program will only reimburse an enrolled chiropractor for deductibles or coinsurance, as appropriate, the spine to correct a subluxation therapeutic service provided by a chiropractor. Coverage is provided by Medicare for X-cine or osteopathy. X-rays, when taken by Chiropractor Manual Policy Guidelines Version 2007 – 1 November 1, 2007 chiropractors is limited to deductibles and coinsurance, a

s appropriate, for Medicarealso prohibited from billing QMBs for payment of any deductible or coinsurance costs. The combined Medicaid and Medicare payments must be considered as payment in full A chiropractor supplier whose QMB claim is denied approval by Medicare may not bill The Medicaid Program permits payment toward Medicare deductibles and coinsurance, with low income and limited assetsindividuals are known as (QMBs). QMBs are individuals who have social services and have been determined eligible for Medicaid paymen

t, as approved services. QMBs are individuals determined eligibleNot all Medicaid enrollees who have Medicare Part B coverage are QMBsMedicaid Eligibility Verification System (MEVS). ent's Common Benefit individual's entitlement to QMB services. A prQMB eligibility by accessing MEVS prio Chiropractor Manual Policy Guidelines Version 2007 – 1 November 1, 2007 coinsurance and deductible payments, as Medicare approvedMedicare coverage field and indicates only coinsurance and deductible payments, as appropriate, for s

ervices are reimbursable for this enrollee. withoutmay be returned in the Medicaid coverage field along with Limited Payment Coverage iropractors is limited to deductibles and coinsurance, as appropriate, foaccept assignment of Medicare claims for QMBs. Medicaid enrolled chiropractors are also prohibited from billing QMBs for payment of any deductible or coinsurance costs. The combined Medicaid and Medicare ces provided to QMBs by Medicaid A chiropractor whose QMB claim is denied approval by Medicare may not bill Medicai

d Chiropractor Manual Policy Guidelines Version 2007 – 1 November 1, 2007 ne or to demonstrate the existence of a Medicare deductible and coinsurance for the X-ray may also be available under Chiropractor Manual Policy Guidelines Version 2007 – 1 November 1, 2007 For the purposes of the Medicaid Program and as used in this Manual, the following term is defined to mean: Qualified Medicare Beneficiaries (QMBs) Medicare beneficiaries with low incomeedicaid payment, as appropriate, surance for Medicare approved s