Coding and Reimbursement for Chiropractors

Insurance companies use a variety of tactics to make it more difficult for chiropractors to claim payments, as well as ways to minimize the reimbursements they do authorize. Insurance coding and reimbursement can be one of the biggest headaches for any chiropractic practice.

Coding and Reimbursement Today

If you’ve been in business for awhile, the operating procedures that got your patients’ claims paid in the past may not be enough to protect your income today. Here are a few tips to help you get the insurance benefits that both you and your patients need, expect, and deserve.

• Use your Insurance Verification Form. Enhancing your standard verification procedures can help ensure there are no unexpected surprises. Some insurance firms now charge separate copays for Extremity Adjustments when they’re performed in the same session with a spinal adjustment; others use the same tactic when physical therapy or massage is used in conjunction with an adjustment. Do double due diligence to ensure you and your patients don’t get stuck holding the bill.
• Get an actual quote on how much will be paid for scheduled care. These days, everyone who deals with insurance companies knows the phrase “verification is not a guarantee of payment.” But you may still have legal appeal rights if the company actually misrepresents benefits or keeps you from building a reasonable fee schedule. Submit a written request to establish a right to benefit disclosure, and you’re more likely to find the company willing to give you accurate and complete information.
• Watch for “deductible calculations provisions.” Complex deductible calculation can make it all but impossible to simply determine the amount of your patient’s deductible up front. Take the time to understand what has been calculated and applied toward the deductible to date, so you understand what’s left and which of your services can actually be calculated and applied toward that deductible.
• Find out whether the insurance carrier is accredited by the Utilization Review Accreditation Commission (URAC). If they’re not, it’s a red flag that they may give you trouble. If they are accredited, they’re required to follow detailed procedures. They’re required to make decisions based on a strict chain of contingencies and must provide certain information upon request.
• Get the name of who you spoke with while verifying insurance benefits. This can be critical to win an appeal at a later time.
• Bill physical therapy. Many insurance plans readily pay for therapeutic exercises and preventive care, since it can increase chances that patients will be healthy in the future. Incorporate physical therapy into your patients’ treatment, and you may be more likely to receive equitable and reasonable reimbursements.

Once you’ve got an effective procedure in place for today’s insurance billing atmosphere, you’ll be able to better protect your livelihood. With some planning, coding and reimbursement procedures can be manageable, minor inconveniences.

Don’t lose that hard-won income through unexpected legal problems. Protect your patients and your business. Give us a call or fill out our online form for more information on how to make your Chiropractic office HIPAA compliant or try us at www.hipaacomplianceservices.com

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