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Chiropractic Coding & Compliance Alert

Reader Question:

Reimbursement to a Non-Par Provider

Question: How does the reimbursement differ when a non-par provider of chiropractic services chooses to accept assignment on a claim?

Minnesota Subscriber

Answer: All providers, whether participating or non-participating/non-par, must bill Medicare for the covered services to avoid a penalty. However, the reimbursement differs in the two categories in that the carrier. “Participating Providers” are paid at 100 percent of the physician fee schedule, with a precondition that they must accept assignment and accept program payment as payment in full, except for any unmet deductible and coinsurance. On the other hand, the “Non-par/Non-participating providers” are paid at 95 percent of the physician fee schedule and may accept assignment on a claim-by-claim basis.


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