MEDICARE PATIENTS. 1. Although Patient may be an eligible Medicare beneficiary, Practice has informed Patient that Dr. Day (Physician) has opted out of the Medicare program effective Oct 1, 2019 for a period of at least two years. Physician has voluntarily opted out of Medicare participation and has not been excluded in any way.
2. Patient understands that, because Physician has opted out of the Medicare program, Medicare will not pay Practice or reimburse Patient for any service provided hereunder; these services will not be covered services under the federal Medicare program. Furthermore, Medicare will not directly reimburse Patient for any such services, and Patient agrees not to submit a claim to Medicare for reimbursement.
3. Patient has been advised and acknowledges that no Medicare fee limitations or any other restrictions or regulations apply to the charges for the services hereunder.
MEDICARE PATIENTS. I understand that Medicare may deny payment for certain services such as services they determine are not medically necessary and I agree to be personally and fully responsible for any such charges.
MEDICARE PATIENTS. Patients with Medicare or Medicaid, please be advised there may be an applicable co-pay for services rendered. I authorize Medicare benefits be made either to me or on my behalf to Health Ministries Clinic, Inc. for any services furnished me by Health Ministries Clinic, Inc. I authorize any holder of medical information about me to release to the Centers for Medicare & Medicaid Services (CMS) and its agents any information needed to determine these benefits or the benefits payable to related services. I understand my signature requests that payment be made and authorizes release of medical information necessary to pay the claim. In Medicare assigned cases, the physician or supplier agrees to accept the charge determination of the Medicare carrier as the full charge, and the patient is responsible only for the deductible, co-insurance, and non-covered services. Coinsurance and the deductible are based upon the charge determination of the Medicare carrier. I agree to contact HMC via phone, website or patient portal prior to the event that I need to cancel or reschedule my appointment. I understand all appointments (i.e., medical, dental and behavioral health) are considered a no show if I fail to report to the clinic for a scheduled appointment. A no show will be implemented when a patient shows for their appointment 10 minutes or more after appointment. I understand I need to arrive 15 minutes prior to my appointment time, to complete the required check-in process and pay fees at the reception desk. I agree if I have two (2) no- shows within a one-year period, I will be required to meet with a Patient Care Coordinator and/or designee prior to scheduling another appointment. I understand if I have a third (3) no-show in a one-year period, I may be informed I will no longer have the ability to schedule future appointments or possibly be placed on “same day scheduling” for a minimum of six (6) months. I understand If I have scheduling privileges suspended, I may request that my status be reviewed by the Chief Executive Officer and/or designee. I acknowledge I understand the expectations about the need to keep my scheduled appointment and the potential consequences if this fails to happen.
MEDICARE PATIENTS. If any patient referred to you through our Services is a Medicare beneficiary, then notwithstanding anything to the contrary in this or any other agreement with us, the patient will only pay the Initial Payment for use of our Service to hold an appointment. UBERDOC will only pay you only the Initial Payment less applicable Transaction Fees. You shall not be entitled to any consultation fee through UBERDOC for consultations to Medicare beneficiaries. If you are a Medicare provider, you agree that any services rendered by you to a Medicare beneficiary (including the initial consultation) will be billed through Medicare in accordance with government regulations and that you will not xxxx the patient directly.
MEDICARE PATIENTS. If you have Medicare as your primary insurance carrier, but you do not have a secondary insurance, you are responsible for the deductible, copay and co-insurance at the time of service. You are also responsible to pay for services not covered by your Medicare insurance unless you have a secondary insurance. You will be required to sign an Advanced Beneficiary Notice for non-covered services.
MEDICARE PATIENTS. SIGNATURE ON FILE- I request and authorize payments of Medicare benefits be made to Gainesville Heart Group, PC., for any services furnished me by the listed provider/supplier. I authorized any holder of medical information about me to release to the Centers for Medicare and Medicaid Service and its agents any information needed to adjudicate these benefits for services. I understand my signature requests that payment be made and authorizes release of all information necessary to adjudicate the claim. If “other health insurance” is indicated in Item 9 of the CMS-1500 form or their approved claim forms or electronically submitted claims, my signature authorizes the release of all information to the insurer as necessary to adjudicate the claim. In Medicare assigned cases, the provider or supplier agrees to accept the charge determination of the Medicare carrier as the full charge, and that I am responsible for the deductible, coinsurance, and any non-covered services.
MEDICARE PATIENTS. 1. Although Patient may be an eligible Medicare beneficiary, Practice has informed Patient that Xx. Xxxxxxxxx (Physician) has opted out of the Medicare program effective June 1, 2018 for a period of at least two years. Physician has voluntarily opted out of Medicare participation and has not been excluded in any way.
2. Patient understands that, because Physician has opted out of the Medicare program, Medicare will not pay Practice or reimburse Patient for any service provided hereunder; these services will not be covered services under the federal Medicare program. Furthermore, Medicare will not directly reimburse Patient for any such services, and Patient agrees not to submit a claim to Medicare for reimbursement.
3. Patient has been advised and acknowledges that no Medicare fee limitations or any other restrictions or regulations apply to the charges for the services hereunder.
MEDICARE PATIENTS. As a Medicare provider, your chiropractor is required to consult and conduct a new patient examination before treating you. Medicare, however, does not reimburse for new patient chiropractic examinations. This is an out-of-pocket cost for you – the patient. Medicare only covers chiropractic adjustments of the spine and spinal subluxations. The new patient examination fee is $125.00. If you develop a new condition, a re-examination is required. Our fee is $75.00. If you have not seen the doctor within three months, a re-exam is necessary to treat you. Treatments on other areas of the body are considered non-covered services and patients are responsible for the fees. Medicare does not cover therapy including ultrasound, electronic muscle stimulation, traction, massage therapy, counter strain muscle work, rehabilitation, neuromuscular reeducation and acupuncture or laser therapy. The fees for these services range from $20 to $65 per treatment for each service. This applies to Medicare patients and patients whose insurance is a Medicare Advantage plan. Examples of Medicare Advantage plans are Secure Horizons by United Healthcare, Cigna Medicare HMO/PPO plans, Security or Freedom BCBS plans. Medicare Advantage plans also are usually subject to a co-pay. Medicare will cover 80-percent of the adjustment or spinal manipulation. Supplemental insurances will cover the 20-percent of the adjustment NOT covered by Medicare. Supplemental insurances will not cover any therapies or treatments not approved by Medicare. If you have a true secondary insurance, therapies may be covered by your carrier. However, we require payment for services upfront. We will kindly xxxx your secondary insurance and if the doctor is reimbursed, we will issue a refund to you within 45 days of payment. Please understand these are not our policies, but federal Medicare guidelines and policies. It’s federal law; please don’t ask us to break it! I understand my Medicare coverage and I understand that I may be responsible for services NOT coverage by Medicare. I have also signed a Medicare ABN – Advance Beneficiary Notice required by Medicare. We do not send paper statements. This policy saves both of us time and money. We ask that you pay your portion at the time of the visit. Or as an alternative, you may leave a credit card authorization allowing us to charge your portion directly to a credit/debit card, once the insurance card has processed. If you require a receipt or a copy of your account, w...
MEDICARE PATIENTS. For Medicaxx xxxxxnts, as soon as reasonably practicable after Closing, each Heritage caregiver responsible for a particular home healthcare patient shall visit the patient for and on behalf of Lovelace and complete an Oasis patient discharge form to dischargx xxx xxtient from Lovelace's home healthcare system. The day after discharge, the Hxxxxxxx xxregiver shall again visit the patient to complete applicable Oasis admission forms to admit the patient to Heritage's home healthcare service ("Medicare Admission Date"). Heritage shall commence providing home healthcare services to the patient as necessary or appropriate on and after the Medicare Admission Date.
MEDICARE PATIENTS. If you do NOT have supplemental insurance, you will be responsible for the twenty percent (20%) co-insurance portion not paid by Medicare as well as any deductible amounts not yet met. It is your responsibility to keep track of therapy cost totals for the purpose of not exceeding the Therapy Cap (unless your diagnosis is exempt from the Cap).
