Are you seeing patients without a PTAN?

QUESTION: Can chiropractors treat Medicare patients without a Medicare Provider Transaction Access Number (PTAN)?

ANSWER: Absolutely not! Chiropractors must obtain a PTAN in order to treat Medicare patients. You are required by Federal Law to submit claims to Medicare for spinal manipulation – this goes for active treatment AND wellness/maintenance care.

Claims must be submitted for “covered” services. Compliance to mandatory claim filing requirements is monitored by CMS. Violations of the requirement may be subject to a civil monetary penalty of up to $2,000 for each violation. Email natasha@targetcoding.com to get a copy of this legal ruling.

These laws and statutes may seem unreasonable, but these are the rules and you must know the rules to know if you’re following or breaking them.

Some DCs say “I’m not in Medicare and just collect cash from Medicare patients.” This is a HUGE mistake -– DO NOT do this.

Can you just opt-out? Unfortunately, chiropractors are not allowed to opt-out of Medicare.

You basically have only 2 choices:

1) Accept Medicare patients into your practice as a par or non-par provider

2) Do not see Medicare patients at all.

Treating Medicare patients can be financially rewarding. Think about this: Medicare pays about $35 for spinal manipulation, and you should be getting paid cash for your exams, therapies and x-rays. This can equate to more than some of the commercial health plans you accept. I averaged $55/per visit from my Medicare patients, and you should too.

Do you or your CAs need help updating your I&A and PECOS profiles? Do you need a Medicare PTAN for yourself or associate? Are your Medicare claims getting denied and you don’t know why?

We now offer credentialing services.

Credentialing Services:

  • Medicare PTAN (Individuals & Organizations)
  • NPI (Individuals & Organizations)
  • I&A (Identity & Access System)
  • Revalidation & Re-credentialing
  • Assist DCs, PTs, MDs
  • New Hires & Associate DCs

If you’re like most busy professionals, you do not have time to fill out the extensive Medicare PTAN application forms…this is where we can help.

We Do the Work for You!! Getting a PTAN has never been easier.

Email jpecoradc@wbcgp.com for more info.


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