We received this question from a chiropractic practice:<\/p>\n
\u201c<\/em>I have noticed my insurance reimbursements are gradually decreasing since January 2022. I have also received a letter from one of my insurance companies that says my charges for 9894x and 992xx codes are higher than my peers. Can you tell me what\u2019s wrong<\/em>?<\/em>\u201d <\/em><\/p>\n As a managed billing service provider for chiropractic practices, we often come across practices that have high accounts receivables and they aren\u2019t sure what\u2019s the reason behind it.\u00a0A few years back, the HHS Office of Inspector General (OIG) reported that 80-94% of chiropractic documentation is incomplete and\/or incorrect<\/a><\/span>. Most DCs aren\u2019t deliberately and knowingly miscoding or making documentation errors. It\u2019s a result of a lack of awareness, ignorance, or being overwhelmed.<\/p>\n Is your chiropractic practice sending out billing and coding red flags to auditors? Read this blog to learn how you can improve your chiropractic documentation and coding and avoid dreaded audits. You will also learn how using the right software and expert help will keep your billing in check and practice protected.<\/p>\n Let\u2019s start with one chiropractic CPT code and what documentation you need for that. For instance, you\u2019re billing a 98941. What are the requirements for that code? Use of 98941 requires a minimum of 3-4 regions of complaint and diagnosis. You need to do manipulation in those 3-4 regions. Now, let\u2019s take, for example, you\u2019re billing Optum for this chiropractic CPT code. According to Optum, the use of 98941 requires documentation that shows manipulative treatment was done to 3-4 regions of the spine and one of the following \u2013 validated diagnoses for 3-4 regions or validated diagnoses for two regions and one or two adjacent spinal regions with documented soft tissue and segmental findings. Accurate documentation is crucial to ensure your <\/span>chiropractic insurance claim<\/a>\u00a0is approved without issues. That takes us to the first point of how to improve your chiropractic billing and coding.<\/span><\/p>\n If the insurers with which you participate have specific rules and you\u2019re not following them, you\u2019re violating the agreement you signed with the insurance company. Most insurance companies publish Medical Review Policy (MRP) that outlines what\u2019s expected for specific treatments, including chiropractic care.\u00a0Your providers and billing officers need to know the rules in order to ensure correct coding and usage of proper documentation.<\/p>\n The best way to set documentation and coding standards in our practice is to use reliable resources.<\/p>\n Chiropractic coding and billing information are constantly changing. Policymakers introduce new chiropractic codes, definitions, and rules for chiropractic CPT codes and ICD-10 codes. If you don\u2019t stay current, your billing will suffer. The best way to stay up to date with the coding changes is to use chiropractic billing software<\/span> that is updated automatically every time new coding policies are introduced. Just a reminder for your practice: New changes to ICD-10 chiropractic codes become effective on the calendar year of October 1<\/a><\/span>, and CPT code changes go into effect on the calendar year of January 1 on an annual basis.<\/p>\n There is a huge difference between medically necessary care and clinically appropriate care, especially when it comes to chiropractic coding and billing. Medically necessary care is episodic care that has a clear beginning, middle, and end of treatment. Maintenance therapy is a care service that seeks to prevent disease, promote health, and enhance the quality of life. Weekly adjustments performed on a senior patient for his arthritic hip pain may help the patient feel better, but the treatment won\u2019t be considered medically necessary if there is no documented functional improvement. Medicare doesn\u2019t pay for maintenance care. Likewise, if you want insurance companies to pay for your chiropractic treatment services, they expect you to provide documentation of day-to-day progress. Therefore, make sure you include questions in the subjective portion of the SOAP note that aligns with the functional goals of the treatment plan on an encounter-to-encounter basis. Each patient is unique. Each encounter is unique. Make sure your documentation for every encounter with a patient reflects the necessary objective, subjective, treatment, and plan.<\/p>\n If chiropractic CPT codes<\/a><\/span> are billed without modifiers when it is required, the insurance company will deny the claim with justification on the EOB of clubbing with another service. Modifiers help to distinguish specific CPT codes and keep codes from being bundled into another service. While there are several modifiers, five modifiers are the most commonly used in chiropractic care:<\/p>\n Check out here<\/a><\/span> when and how to use these five chiropractic modifiers when submitting a claim. Now when you know how you can improve your chiropractic documentation, let\u2019s check out some common claim form mistakes that you must avoid to eliminate all those red flags that could lead to audits.<\/p>\n This date is the date when the patient presented for care for the current episode of treatment. Don\u2019t forget to change the Date of Current Injury\/Illness in your SOAP notes and field 14 of your HCFA claim forms.<\/p>\n The diagnosis box number 21 in the HCFA form tells insurance companies that your provider has provided adequate support services using the applicable diagnosis. If you use the same diagnosis on every patient visit and\/or on every patient, it might draw the attention of auditors.<\/p>\n Major insurance policies have allowed fees for covered and payable services. If your practice is charging excessive or outside (above\/below) for chiropractic codes than what your peers charge for the same services, it could result in some types of audits\/reviews.<\/p>\n This is the NPI of the provider who rendered services to the patient. If your practice has multiple providers, they must have unique and individual NPI numbers. Make sure the claim form clearly mentions the NPI number of the provider who performed chiropractic services on the patient.<\/p>\n Diagnosis pointers indicate the appropriate order of importance in relation to the services being performed. Make sure the same diagnosis code doesn\u2019t point to multiple services. The diagnosis pointer (Box 24E in HCFA) references the line number from Box 21.<\/p>\n Conclusion<\/strong><\/p>\n If you follow the aforementioned tips and avoid common claim mistakes, your practice can keep your documentation and coding on the right track. If chiropractic practices know the reimbursement policies, follow standard documentation guidelines, stay current with coding changes, and use chiropractic ICD-10 and CPT codes appropriately, they can get paid for what they\u2019re owed. If you feel overwhelmed with insurance billing or need help with your high accounts receivables, our managed billing experts can help you. With our chiropractic billing services, you can keep billing and coding on the right track while increasing your revenue. Talk to our insurance billing expert for free.<\/p>\n Request a Demo<\/a><\/strong><\/p>\n <\/p>\n Related Articles:<\/span><\/strong> In-House Chiropratic Billing or Outsource It – That’s A Million Dollar Question!<\/span><\/a><\/p>\n 6 Effective Tips for Chiropractic Practices to Improve Billing and Claims Process<\/a><\/p>\n 5 Things to Consider When Selecting Chiropractor Billing Software<\/a><\/p>\n1. Understand Your Insurance <\/b>Company’s Policies<\/b>\u00a0<\/b><\/span><\/h2>\n
2. Chiropractic Documentation : Follow Standard Guidelines <\/b><\/span><\/h2>\n
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3. Stay Current with the Coding Changes<\/b><\/span><\/h2>\n
4. Medical <\/b>Necessity<\/b><\/span> vs. Maintenance Care<\/b><\/h2>\n
5. Use Modifiers Properly<\/strong><\/b><\/h2>\n
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