The Medicare Denial Letter:
useful for this period of history when Medicare does not cover acupuncture services
When a patient is eligible for Medicare, but Medicare does not cover acupuncture nor acupuncturists as providers, what is the process in billing for care?
How do you process coverage for a Medicare-qualifying patient in a CMS facility?
- “Effective April 1, 2019, only the revised 01-18 version will be accepted for the Form CMS-1490S. the provided link below includes the form and all the applicable instructions. Please read all instructions prior to submitting a claim to Medicare. (1) The Form CMS-1490S is fillable, can be completed online, printed then mailed. (2) Mail the completed form and itemized bills to the correct Medicare Administrative Contractor as indicated on pages 7 through 18 of the instructions.”
- If you read this and the form is again outdated or you want to make another correction, please note it in the comments below or contact me at the website. Thank you.
“We have kept a denial letter from our early insurance years stating the denial. We keep this letter and send it to the secondary insurance. Most supplement insurance will not cover what Medicare does not deny. The one supplement insurance I have noticed covering acupuncture in my region this year is a Medicare Advantage plan, ‘UnitedHealthcare AARP Medicare Advantage Supplement’. However, a true secondary insurance may have coverage. “–Timothy Suh
“Personally, I believe Medicare is a fight worth fighting for. [In a few years it is likely] we will have coverage. All the signs point toward it. The only issue is to create the data that backs our medicine in a biopsychosocial model that is accepted by the current system.” -Bobbee Vang
- The fill-able form, “request for medical reimbursement” is on the CMS website.
- The screenshot at the top of this post is an example of what a Medicare Denial Letter looks like.
- Once you have a Medicare Denial Letter for a specific patient, keep it.
- This letter is good “forever” or until the law changes.
- It takes an Act of Congress for a profession to be added as a covered benefit in Medicare law/Social Security Act. For more info see section 1861 of the Social Security Act.
- “Medicare is a defined benefit program. For an item or service to be covered by the Medicare program, it must fall within one of the statutorily defined benefit categories outlined in the Social Security Act.”—cms.gov
- What is CMS?
- The CHRONIC Care Act: A Health Policy focused on Addressing the Social Determinants of Health
- For more on team communication techniques like BLUF and SBAR, see the HH Project’s
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