An Insight into Medicare and other
Chiropractic Billing Service Guidelines
Accurate chiropractic medical billing requires adherence to specific rules depending on insurance as well as the state that the services are provided.
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Phone: 1-800-670-2809
Appropriate chiropractic billing services are critical for any chiropractor’s office. Chiropractic care has gained much popularity in recent years, as it helps reduce expensive medical testing, unnecessary surgical interventions and accompanying hospital admissions. Several reports highlight the fact that the demand for chiropractic care is increasing with more and more people relying on this non-surgical treatment approach.
According to the Illinois Chiropractic Society, around 6 percent of the general population utilizes chiropractic.
Technavio’s latest market research report predicts that the global chiropractic care market will grow at a CAGR of nearly 4% during 2017-2021. The increasing older population is the major factor behind the market’s growth. Geographically, the Americas are expected to continue market dominance in the next four years as well.
A new study conducted by researchers from the VA Connecticut Healthcare System finds that the annual number of chiropractic visits has increased by nearly 700 percent, thus demonstrating more veterans have access to chiropractic care than ever before.
Chiropractic Medical Billing – Is It Complex? Chiropractic
treatment
plans
may
include
spinal
manipulation,
soft
tissue
work,
rehabilitative exercises, physical therapy, and nutritional lifestyle counseling.All claims for chiropractic services must include details such as Date of the initiation of the course of treatment,
Symptom/condition/Secondary
diagnosis
code(s),
Subluxation(s)/Primary
diagnosis code(s), Date of Service, Place of Service, Procedure Codes and other relevant details. Failure to report these items will result in claim denial or delay.With frequent changesin medical codes and specific regulations affecting reporting for this specialty, chiropractic billing can be quite complex. Major restrictions are the coverage limitations.
Medicare coverage for chiropractic service is specifically limited to treatment by means of manual manipulation, i.e., by use of hands. No other diagnostic or therapeutic service furnished by a chiropractor is covered. Also, maintenance care is not reimbursable by Medicare.
If a chiropractor orders, takes, or interprets an x-ray or any other diagnostic test, the x-ray or other diagnostic test can be used for claims processing purposes, but Medicare coverage and payment are not available for those services.
www.outsourcestrategies.com
Phone: 1-800-670-2809
Medicare does not cover chiropractic treatments provided for extraspinal regions (CPT 98943), which includes the head, upper and lower extremities, rib cage, and abdomen.
With all such rules and restrictions, processing the claims in-house often leads to medical office
personnel
frustration,
billing
backlog,
claim
denials,
and
unhappy
patients.
Professional chiropractic insurance billing service can help practices to reduce error rates, achieve compliance and maximize revenue.
Comprehensive Chiropractic Billing Process Enrollment into the billing system – All demographic and insurance details must be recorded by the chiropractor and kept on file. The date of the initial treatment or date of exacerbation of the existing condition must be entered in Item 14 of Form CMS-1500. Charge entry - A key step in medical billing, the process refers to entering the charges for services that the patient received. As this will determine the physician’s reimbursements for the services rendered, the entry process also includes the appropriate linking of medical codes to services and procedures rendered during the patient's visit. Insurance verification and authorization - Most patients enter the office with some sort of insurance that covers chiropractic treatments. It is crucial to verify their insurance information and eligibility before every appointment. Professional medical billing companies will verify plan type, plan exclusions, effective dates, patient policy status, primary and secondary payable benefits, in network and out-of-network benefits, out-of-pocket costs, referrals and pre-authorizations and other specific details online or by directly calling the insurance payers. Accurate coding– Exact CPT, ICD-10 and HCPCS codes are vital in medical claims for the insurance payers to know what exactly the patient is being treated and the method of treatment the patient is undergoing. Accurate CPT and HCPCS code modifiers should also be included to provide additional information about the service or procedure performed. Claims submission – Many companies now use advanced software for a smooth claim submission process. Most insurance companies follow a standard set of guidelines for billing and it is necessary for the billing specialists to follow them.
www.outsourcestrategies.com
Phone: 1-800-670-2809
ď ś A/R follow up–Clear submission of claims alone will not assure reimbursement. Following up with payers on unpaid claims is a crucial step in revenue cycle management. With such follow-ups, medical billing outsourcing companies help detect issues such as non-receipt of claims by the payer, claim denial, and claims that are pending due to lack of information about the patient. By partnering with an experienced medical billing company, chiropractors can benefit from the services of AAPC-certified coders and billing specialists who are well versed in, and up-to-date with the specific rules and regulations.
www.outsourcestrategies.com
Phone: 1-800-670-2809