Chiropractic care involves specific procedures that need to be coded correctly so insurance companies reimburse chiropractors accurately. Billing services have staff trained in this specific type of coding. Billing Care Solution handle submitting the claims to insurance companies efficiently and accurately to get you paid faster. Incorrect coding or errors on claims can lead to them being rejected by insurance companies. Billing services can help fight these rejections and ensure you get paid for your services. Basically, Billing Care Solution hold upon all the administrative tasks related to getting you paid for the chiropractic care you provide.

Services Billing Care Solutions Offer

Medical Billing & Coding: Billing Care Solution experienced staff is trained in chiropractic coding and will ensure your services are coded accurately according to CPT® and ICD-10-CM guidelines. This minimizes claim denials and maximizes reimbursements.

Revenue Cycle Management (RCM): Billing Care Solution handle the entire revenue cycle, from appointment scheduling and insurance verification to claim submission, payment processing, and denial management. This allows you to focus on delivering quality care.

Account Receivable Management: Billing Care Solution take care of collecting patient payments and following up on outstanding accounts. This ensures you get paid promptly and improves your cash flow.

Provider Enrollment & Credentialing: Billing Care Solution assist you with enrolling in the insurance plans you want to participate in and navigate the credentialing process. This saves you time and ensures you can accept payments from a wider range of patients.

Eligibility & Benefit Verification: Billing Care Solution proactively verify patients’ eligibility and benefits before their visit. This helps avoid surprises and ensures patients understand their financial responsibility.

Authorization and Referral Services: Billing Care Solution obtain necessary prior authorizations and referrals from insurance companies on your behalf. This ensures your services are covered by insurance and reduces the risk of denials.

Business Intelligence Reporting Services: Billing Care Solution provide insightful reports on your billing performance. These reports track key metrics like claim denials, collections rates, and patient demographics. You can use this data to identify areas for improvement and make informed business decisions.

Patient Support: Billing Care Solution offer dedicated patient support to answer questions about billing and insurance. This helps reduce confusion and improves the patient experience.

Codes Used in Chiropractic Billing Services

Chiropractic billing codes are like a secret language between chiropractors and insurance companies. These codes precisely tell the insurance company what kind of treatment you received.

CPT Codes:

CPT codes are action codes. They describe the specific service a chiropractor performed during your visit. The most common ones revolve around chiropractic manipulative treatment (CMT), which is the fancy way of saying spinal adjustments.

  • 98940: This code signifies a chiropractic adjustment involving one or two spinal regions. Maybe your neck and upper back were bothering you, so this code would likely be used.
  • 98941: This code applies when adjustments are performed on three or four spinal regions. Perhaps you had lower back pain radiating down your leg, requiring adjustments in your lumbar and sacral regions.
  • 98942: This code indicates adjustments throughout your entire spine, targeting five regions.
  • 98943: This code goes beyond the spine. It signifies adjustments performed on one or more regions outside the spinal column, like your knee or shoulder.

ICD-10-CM Codes: The Reason Codes

ICD-10-CM codes are reason codes. They tell the insurance company why the chiropractic care was needed. For example, if you came in with lower back pain, the code might be M54.50 (low back pain). These codes help the insurance company understand the medical justification for the treatment.

Modifier used in Chiropractic Billing Services

For signify a significant, separate service

Modifier 25: This signifies a significant, separate evaluation and management (E/M) service performed by the chiropractor on the same day as another service. This is used when the E/M service is more complex than what’s typically included in the base procedure code.

For indicate a separate non-E/M service

Modifier 59: This indicates an important, separate non-E/M service provided by the chiropractor on the same day as another service. A common example is using this with manual therapy (code 97140) performed on the same day as a chiropractic adjustment (CMT codes 98940-42). It clarifies that these are distinct services and should be billed separately.

For Medicare Specific Requirements

AT Modifier (Active Treatment): This is required for Medicare claims when performing active/corrective treatment for acute or chronic subluxations. Claims submitted for Chiropractic Manipulative Treatment (CMT) codes without the AT modifier might be considered not medically necessary.

GA Modifier: This is used with Medicare claims to indicate that an Advanced Beneficiary Notice (ABN) is on file. An ABN informs the patient that a service may not be covered by Medicare and they may be financially responsible.

GY Modifier: This applies to all services except Chiropractic Manipulative Treatment (CMT) for Medicare claims. It signifies that these other services (excluding adjustments) are not covered by Medicare when provided by a chiropractor.

In conclusion, investing in Chiropractic Billing Services is an investment in the long-term financial health and efficiency of your practice. It allows you to focus on your passion for patient care while ensuring you receive appropriate compensation for the services you provide. Partner with Billing Care Solutions today to experience the difference a holistic approach can make. Contact us to learn more about how we can transform your revenue cycle!

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