Over the past several years, various Medicare Administrations have drastically altered Medicare Reimbursement Schedules and Reporting Guidelines to all health care practitioners, including me.
These constantly changing Reimbursement Schedules and Reporting Guidelines have not been favorable to either you the patient, in terms of reduced coverage, or health care practitioners like me, in terms of reduced reimbursement.
Your health care fees are taken very seriously in my office.
Your ability to receive and complete care is important to me.
Medicare's rigid, strict billing procedures and constantly changing rules make it financially prohibitive for me to comply. To do so would add anywhere from 20% to 30% to your current Non-Force Chiropractic fees.
For these reasons, I do not participate with Medicare. I do not have a Medicare Provider Number and I do not submit claims to Medicare. I must ask you, therefore, not to submit claims to Medicare on your own behalf.
This Medicare No Billing Contract discloses that you understand that by accepting my care you will not submit your claims to Medicare and that you will not receive any reimbursement from Medicare.
My hope and dream is that someday the United States will have a socially sustainable and effective, outcome directed, health care system where we may all benefit.
Until then, I am here, outside of Medicare, to help you transform your pain and stress into opportunity and freedom.
I, (your name printed here), understand that John Zeravich, DC is not associated with Medicare and that I will not bill Medicare separately for any services or products from John Zeravich, DC.
I also understand that by accepting care from John Zeravich, DC I am waiving any rights to being reimbursed by Medicare now or anytime in the future.
(Your signature here)___________________________________
*This form complies with Section 1848(g)(4) of the Social Security Act and is required for all Medicare patients.
SF Bodywork Massage > Medicare Policy