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2020 Hawaii Medicare Fee Schedule

HSCA Members only can download the Fee Schedule "HERE"

Latest HI LCD (Local Carrier Determination) This is the "How To" information for Medicare Coding, Documentation & Rules for Medicare Chiropractic Claims. (late 2016 & 2017)

Click on the link "LCD"

Petition for National Medicare Equality


2015 Hawaii Medicare Information

The following link is a downloadable PDF file with all the Chiropractic specific regulations and requirements to file Medicare claims with Noridian.

Note this LCD (Local Contractor Determination) is the final version (posted here today on 10-27-2015). The previous version said "DRAFT", but this new posting superceds the original draft version. This new listing is now the law. (CMS/Noridian made some updates to the ICD-10 required code list for Chiropractic)

Updated HAWAII LCD's


President Obama Signs the Protecting Access to Medicare Act of 2014


Noridian Healthcare Solutions

     On April 1, 2014, President Obama signed into law the Protecting Access to Medicare Act of 2014.  This new law prevents a scheduled payment reduction for physicians and other practitioners who treat Medicare patients from taking effect on April 1, 2014. This new law maintains the 0.5 percent update for such services that applied from January 1, 2014 through March 31, 2014 for the period April 1, 2014 through December 31, 2014.  It also provides a zero percent update to the 2015 Medicare Physician Fee Schedule (MPFS) through March 31, 2015.

     The new law extends several expiring provisions of law.  We have included Medicare billing and claims processing information associated with the new legislation. Please note that these provisions do not reflect all of the Medicare provisions in the new law, and more information about other provisions will be forthcoming.

      Physician Payment Update – As indicated above, the new law provides for a 0.5 percent update for claims with dates of service on or after January 1, 2014, through December 31, 2014. It also provides a zero percent update to the 2015 Medicare Physician Fee Schedule (MPFS) through March 31, 2015. CMS is currently revising the 2014 MPFS (physician fee schedule)  to reflect the new law's requirements as well as technical corrections identified since publication of the final rule in November. For your information, the 2014 conversion factor is $35.8228.

New Hawaii Medicare 2014 Fee Schedule (posted January 29, 2014)

HSCA is pleased to provide HSCA members with a copy of the latest HI Medicare Fee Schedule and some of the related regulations for automobile and workers’ compensation claims. A new section on HMSA/BCBS claims has also been addded.

You will be happy to know that President Obama has signed a law that raises the Medicare Physician Fee Schedule. In addition, the AMA has revalued the CMT codes upward. The net effect is that the majority of our fees have gone up. (CMS did slightly devalue a few of the E&M codes, but very minimally).

Additionally, members will find a current listing of the Only acceptable Medicare ICD-9 diagnostic codes. Noridian, our new Medicare carrier, has adopted these specifically for Chiropractic claims. Remember the primary diagnostic code must always be from the 739.0 thru 739.5 group. You Must have a secondary diagnosis supporting the primary diagnosis, and it can only be one that is on the approved secondary list.

Any questions, please do not hesitate to contact me on the HSCA line: (808) 926-8883.






New Medicare Deductible for 2014: Beginning Jan. 1, the new Medicare part B deductible is $147, same as in 2013. Remember...The deductible is collected on the first $147 of "covered" Medicare services. For Chiropractic the only covered services are spinal adjustments (98940, 98941 & 98942). All other services provided do not meet the deductible criteria.


 2014 HAWAII Medicare Fee Schedule & DOLIR Exhibit "A" Workers’ Comp. Fees

Jurisdiction E  

Medicare Medical Records: Signature Requirements Acceptable and Unacceptable Practices


While CMS guidelines mandate the presence of signatures specifically for all 'medical review' purposes, modifiers, etc., records pertaining to any procedures billed to Medicare are potentially subject to review by not only Palmetto GBA, but other CMS contractors. Because of this, we are alerting you to the importance of these signature requirements and if changes are needed, we suggest you take immediate action.  The contents of this article are applicable to Medicare claims with dates of service on or after March 1, 2010, processed by or medical record submitted to Palmetto GBA for Medical Review purposes on or after April 16, 2010.

 Signature’s Purpose
Medicare requires that services provided/ordered be authenticated by the author.  The signature for each entry must be legible and should include the practitioner’s first and last name. For clarification purposes, we recommend you include your applicable credentials, e.g., P.A., D.O., or M.D.

The purpose of a rendering/treating/ordering practitioner’s signature in patients’ medical records, operative reports, orders, test findings, etc., is to demonstrate that services submitted to Medicare have been accurately and fully documented, reviewed and authenticated. Furthermore, it confirms the provider has certified the medical necessity and reasonableness for the service(s) submitted to the Medicare program for payment consideration.  

Medicare Requirements for Valid Signatures
Acceptable methods of signing records/test orders and findings include:   

  • Handwritten
  • Electronic: 
    • Electronic signatures usually contain date and timestamps and include printed statements, e.g., 'electronically signed by,' or 'verified/reviewed by,' followed by the practitioner’s name and preferably a professional designation.  Note: The responsibility and authorship related to the signature should be clearly defined in the record.
    • Digital signatures are an electronic method of a written signature that is typically generated by special encrypted software that allows for sole usage 

Note: Be aware that electronic and digital signatures are not the same as 'auto-authentication' or 'auto-signature' systems, some of which do not mandate or permit the provider to review an entry before signing. Indications that a document has been 'Signed but not read' are not acceptable.

Acceptable Electronic Signature Examples:

  • Chart 'Accepted By' with provider’s name
  • 'Electronically signed by' with provider’s name
  • 'Verified by' with provider’s name
  • 'Reviewed by' with provider’s name
  • 'Released by' with provider’s name
  • 'Signed by' with provider’s name
  • 'Signed before import by' with provider’s name
  • 'Signed:  John Smith, M.D.' with provider’s name
  • Digitized signature: Handwritten and scanned into the computer
  • 'This is an electronically verified report by John Smith, M.D.'
  • 'Authenticated by John Smith, M.D'
  • 'Authorized by: John Smith, M.D'
  • 'Digital Signature: John Smith, M.D'
  • 'Confirmed by' with provider’s name
  • 'Closed by' with provider’s name
  • 'Finalized by' with provider’s name
  • 'Electronically approved by' with provider’s name 
  • ‘Signature Derived from Controlled Access Password’

Acceptable Written Signatures:

  • Legible full signature
  • Legible first initial and last name
  • Illegible signature over a typed or printed name
  • Illegible signature where the letterhead, addressograph or other information on the page indicates the identify of the signator. Example: An illegible signature appears on a prescription.  The letterhead of the prescription lists 3 physicians’ names.  One of the names is circled.
  • Illegible signature NOT over a typed/printed name and NOT on letterhead, but the submitted documentation is accompanied by: 1) a signature log, or 2) an attestation statement
  • Initials over a typed or printed name
  • Initials NOT over a typed/printed name but accompanied by: 1) a signature log, or 2) an attestation statement
  • Unsigned handwritten note where other entries on the same page in the same handwriting are signed 

Unacceptable Signatures*:

  • Signature 'stamps' alone in medical records are not recognized as valid authentication for Medicare signature purposes and may result in payment denials by Medicare 
  • Reports or any records that are dictated and/or transcribed, but do not include valid signatures 'finalizing and approving' the documents are not acceptable for reimbursement purposes. Corresponding claims for these services will be denied. 
  • Illegible signature NOT over a typed/printed name, NOT on letterhead and the documentation is unaccompanied by: 1) a signature log, or 2) an attestation statement
  • Initials NOT over a typed/printed name unaccompanied by: 1) a signature log, or 2) an attestation statement
  • Unsigned typed note with provider’s typed name
  • Unsigned typed note without provider’s typed/printed name
  • Unsigned handwritten note, the only entry on the page

 Unacceptable Signature Examples*:

  • 'Signing physician' when provider's name is typed
    Example: Signing physician: ______________________
                                                            John Smith, M.D.
  • 'Confirmed by' when a provider's name is typed
    Example: Confirmed by: ______________________
                                                        John Smith, M.D.
  • 'Signed by' followed by provider's name typed and the signing line above, but done as part as the transcription.
  • 'This document has been electronically signed in the surgery department' with no provider name.
  • 'Dictated by' when provider's name is typed
    Example: Dictated by:  ______________________
                                                  John Smith, M.D.
  • Signature stamp
  • 'Signature On File'
  • 'Filled By'
  • ‘Electronically signed by agent of provider’

*For the sections listed above, with an asterisk (*), Palmetto GBA will contact the person or organization that submitted the claim(s) and ask him/her to submit an attestation statement (for missing signatures) or a signature log (for illegible signatures).  The contact may occur via phone or a written request.  The attestation statement must be received within 20 calendar days of the call or the date the written request is received by the post office. In order to be considered valid for Medicare Medical Review purposes, your attestation statement must include the following elements:

  • the printed full name of the physician/practitioner
  • sufficient information to identify the beneficiary,
  • date of service, and  
  • signature and date by the author of the medical record entry. 

Should a provider choose to submit an attestation statement, the following statement may be used:


"I, ____________________[print full name of the physician/practitioner], hereby attest that the medical record entry for _________[date of service]  accurately reflects signatures/notations that I made in my capacity as _______[insert provider credentials, e.g., M.D.]  when I treated/diagnosed the above listed Medicare beneficiary. I do hereby attest that this information is true, accurate and complete to the best of my knowledge and I understand that any falsification, omission, or concealment of material fact may subject me to administrative, civil, or criminal liability.”


While the above statement is an acceptable attestation format, at this time, Palmetto GBA is neither requiring nor instructing providers to use a certain form or format.


Note: The submitter will NOT be contacted if the claim is or will be denied for reasons unrelated to the signature requirement. If the signature is missing from an order, Palmetto GBA will disregard the order during the review of the claims and the submitter will not be contacted.


Question:  What if I can't get a handwritten or electronic signature because the provider is deceased or has left the practice?


Answer:  In these situations, the services are not billable to Medicare.  Palmetto GBA will NOT consider attestation statements from someone other than the author of the medical record entry in question (even in cases where two individuals are in the same group, one may not sign for the other in medical record entries or attestation statements).


Unique Signature Situations:

  • Incident to:
    • Incident to a physician’s professional services means that the services or supplies are furnished as an integral, although incidental, part of the physician’s personal professional services in the course of diagnosis or treatment of an injury or illness. Only the Past, Family, and Social History (PFSH) and Review of Systems (ROS) may be documented by ancillary personnel incident to and incorporated into the E/M documentation, which must be reviewed and signed by the billing provider.
    • Services of non-physician practitioners (NPPs) ordinarily performed by the physician, such as minor surgery, setting casts or simple fractures, reading x-rays, and other activities that involve evaluation or treatment of a patient’s condition, are also covered as services incident to a physician’s professional services. If the NPP performs an entire service incident to the physician (office/clinic/home settings only), the medical record may be signed by the NPP or the physician.
  • Split/shared services:
    • Office setting: When an E/M service in an office setting is a shared/split encounter between a physician and a non-physician practitioner (NP, PA, CNS or CNM), the service is considered to have been performed 'incident to' if the requirements for 'incident to' are met and the patient is an established patient. The service is reported using the physician’s National Provider Identifier (NPI) number. The physician must sign.  If 'incident to' requirements are not met for the shared/split E/M service, the service must be submitted under the NPP’s NPI number.  The billing NPP provider must sign.
    • Hospital-based setting: When a hospital inpatient/hospital outpatient or emergency department E/M is shared between a physician and an NPP from the same group practice and the physician provides any face-to-face portion of the E/M encounter with the patient, the service may be submitted under either the physician's or the NPP's number. However, if there was no face-to-face encounter between the patient and the physician (e.g., even if the physician participated in the service by only reviewing the patient’s medical record), then the service may only be submitted under the NPP's number. The billing provider (physician or NPP) as determined above must sign.
  • Assistant at surgery: Surgical assistants are not required to sign the operative report in addition to the responsible surgeon, when reference is made in the operative note that identifies the assistant, and provided that the report contains an acceptable signature by the responsible surgeon
  • Co-Surgeons: The co-surgeon must follow the signature requirements and each co-surgeon must sign his/her operative report
  • Scribes: The signature of the scribe is not required. The scribe's name must be listed in the medical record and identified as a scribe. The signature requirements for the billing provider still apply.


Electronic Medical Records: Recommendations
The electronic system you select should include a process that verifies the individual signing his/her name has reviewed the contents of the entry and determined it contains what he/she intended.


Safeguards must be in place to protect against unauthorized access and inappropriate use of your electronic signatures, by whatever method, by anyone other than the designated individual to whom it is assigned. It is to be unique to the individual, and not reassigned nor reused by someone else. Furthermore, measures should be in place to protect the 'links' between electronic health information and signatures which prevent unapproved alteration through removal, copying or transfer.


To avoid unnecessary payment denials, rejections or overpayment situations, we strongly urge providers to check with their technical staff or software vendors to verify their current record-keeping and signature processes are in compliance with CMS instructions. Software/hardware should meet or exceed industry standards to avoid compromising the integrity of documentation and signatures.


For additional information please refer to the Medicare Program Integrity Manual, Pub. 100-08, Chapter 3, Section and MLN Matters article # MM 6698. They are accessible through the following three links: 

last updated on 04/15/2010


CMS Increases On-Site Inspections—Make Sure Your Enrollment Record is Up to Date

If you change office locations, change your business name, or change your business structure, you must report these changes to your Medicare contractor. The Centers for Medicare and Medicaid Services (CMS) has developed a complete list of provider reporting requirements along with the timeframes within which providers must report specific changes. It is very important to be aware of these requirements because if changes are not reported in a timely fashion, a provider’s billing privileges can be revoked.

Additionally, in an effort to validate enrollment records, CMS has also indicated that it is conducting more on-site inspections to determine if a provider is practicing at the location on record.

For more information about what to expect during an on-site inspection, go to page 267 of the Medicare Provider/Supplier Enrollment Chapter of CMS’s program integrity manual. For a list of frequently asked questions about the Medicare enrollment process, click here

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