Medicare is a federally funded health assistance program that provides medical benefits for individuals with low incomes. This is regulated by both the federal and state government based on certain criteria of eligibility.
You need to be careful about the medical device companies which sell spinal decompression tables promising that the private providers will reimburse for the service. This is because, in reality, both Medicare and most of the private insurance companies do not cover this therapy.
This is not known to many doctors and coders as yet. Hence, while billing for the medical services, this medical service is billed under physical therapy or surgery categories and applied for medical expenses reimbursement. These claims are wrong and in fact, illegal and could be a huge blow to the Medicare program and also the private insurance providers since it could alleviate the cost by more than 65 million dollars every year.
Investigations are currently on to curb this illegal practice of billing spinal decompression therapies under Medicare benefit expenses. But this has also increased the cost of Medicare audits, penalties and repayment costs. Fraud alerts have been issued to identify those medical organizations who are trying to bill these therapies under a different medical code to avail Medicare assistance.
So far, some of these illegal billings have been identified where the claims have reached a whooping cost of up to $1 million! It has also been found that the Centers for Medicare and Medicaid Services (CMS) do not update its policies when new medical devices hit the market and this has resulted in a lot of confusion regarding the coverage criteria.
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- Medicare Coverage For Spinal Decompression
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