Chiropractic Billing: Best Practices to Ahead of the Curve

Billing for chiropractic care is complex due to the complexities of payer rules and compliance guidelines. This article offers tips to ease chiropractic RCM challenges.

With the complexities of payer rules and compliance guidelines, billing and coding for chiropractic care can be a daunting task. While chiropractors focus on delivering high-quality patient care, it’s crucial to maintain effective revenue cycle management (RCM) to minimize denials and ensure a healthy cash flow. Utilizing professional chiropractic billing services can ensure efficient support to address RCM challenges and enhance reimbursement rates. In this article, we share valuable tips to optimize your billing and coding processes in your chiropractic practice.

Strategies to Optimize Chiropractic Billing and Coding

Verify Patient Insurance Coverage in Advance

Always verify patients’ coverage and benefits before providing services. This can help prevent claim denials and ensure timely payment. Insurance companies have varying coverage policies for chiropractic care, causing uncertainly about what is billable and what is not.

Performing insurance eligibility verification prior to the patient encounter will help you determine if patient is covered as well as any limitations to their coverage. Reaching out to an insurance verification company can make this easier. In addition to utilizing online resources, experts contact the insurance company directly to verify coverage.

Accurate Coding

Chiropractic billing involves specific CPT and ICD-10 codes that can be complex and subject to frequent changes, making accurate coding a challenge. To properly diagnose conditions and assign ICD-10 codes with the highest level of specificity, practitioners must possess thorough and current knowledge of chiropractic billing codes and guidelines. In 2024, there are several new codes that impact chiropractic billing. Coding errors can lead to payment denials or delays.

Here are some examples of the complexity of chiropractic coding:

Eachcode for Chiropractic Manipulative Treatment (CPT codes 98940-98943), corresponds to a specific number of regions treated, regardless of the number of manipulations performed in each region. If chiropractic manipulation is applied to the C3 and C5 vertebrae during the same visit, it is considered treatment for only one region (cervical) and should be reported using CPT code 98940. Additionally, all CPT codes must be accompanied by a supporting ICD-10 diagnosis code to justify the level of care provided.

Keeping abreast of coding changes and compliance requirements reduces the risk of audits and penalties, ensuring your practice has a better chance of receiving insurance approval on the first submission. Allocate time for ongoing education and training, particularly if your practice management software doesn’t automatically update codes in your chiropractic billing workflows.

Complete and Accurate Documentation

Documentation is critical to demonstrate chiropractic care. Every service provided should be clearly documented to show medical necessity, along with the relevant diagnosis codes and procedure code. A CMS billing coding and article states: “…the precise level of subluxation must be specified on the claim and must be listed as the primary diagnosis. The neuromusculoskeletal condition necessitating the treatment must be listed as the secondary diagnosis”. Not documenting these details will result in claim denial or delay.

Use Modifiers

Using modifiers is important for appropriate reimbursement. Modifiers aim to provide payers with additional information needed to process a claim. They allow the provider to indicate that a service or procedure has been changed due to some specific circumstance but has not changed in its definition or code.

For example, using modifier 25 would indicate that a separately identifiable E/M service was provided on the same day as chiropractic manipulation. Another example is modifier 22, which is appended to the usual CPT code to indicate that the work required to provide a service is substantially greater than typically required. Documentation should clearly justify the substantial additional work performed, along with the reason for it. This includes factors such as increased intensity, extended time, technical difficulty of the procedure, the severity of the patient’s condition, and the physical and mental effort required.

Timely filing

Timely billing is essential to secure prompt payment. Each insurance payer has specific filing deadlines, so it's important for chiropractors to submit claims within the designated timeframe. Billing staff should be familiar with the filing limits for each payer to ensure your claims are submitted on time and payments are received without delay. Missing these deadlines can lead to claim denials or payment delays.

Provide Clear Pricing and Payment Options

Transparency is essential for building patient trust and satisfaction. Establishing clear pricing and payment options is a great way to improve chiropractic billing. Clearly presenting your fee schedule and payment policies to patients from the start helps them understand their financial responsibilities. Practices can also benefit from offering flexible payment options, such as payment plans or online payment portals. Enhances convenience and accessibility for patients can drive timely revenue collection.

Obtain Prior Authorizations

Whether chiropractic care requires preauthorization depends on the insurance plan and the type of service. Humana requires prior authorization for chiropractic therapy, including manipulative therapy. United Healthcare requires prior authorization for chiropractic services in multidisciplinary offices and outpatient hospital settings, but not for services provided in the home. Medicare Advantage (MA) plans may require prior authorization for chiropractic services. Obtaining preauthorizations is essential to ensure patients receive the timely care they need.

Partner with an Expert

Insurance regulations and compliance guidelines are continually changing. Keeping up-to-date with these changes helps minimize the risk of audits or penalties and increases the chances of getting insurance approval on the first submission. Partnering with an experienced provider of chiropractic billing services is a practical way to overcome billing and coding challenges. Chiropractic billing experts will conduct audits for identifying inefficiencies, spotting errors, and uncovering compliance gaps. They will follow up promptly to resolve any issues and resubmit the claims, ensuring accurate and timely reimbursement for your services.