Chiropractic Billing Services

Streamline Outsourced Chiropractic Medical Billing Services with A1MCA

Chiropractic billing is the structured process of submitting and following up on claims to secure reimbursement for chiropractic services rendered by practitioners. This billing process is vital for chiropractic clinics to ensure accurate and timely payments for various services, including Chiropractic Manipulative Treatment (CMT), physical therapy modalities, diagnostic imaging, and rehabilitative services.

The foundation of chiropractic billing relies on the precise use of codes to classify services, including CPT codes, ICD-10-CM codes, HCPCS codes, etc. These codes must be accurately assigned to match the services provided, ensuring that insurance companies recognize the procedures and offer appropriate reimbursement.

Implementing a structured billing approach allows chiropractic practices to reduce errors, prevent revenue loss, and ensure timely payment, ultimately enhancing cash flow. Nevertheless, chiropractic practices often face various challenges in their billing processes. These challenges include the intricacies of insurance coverage, frequent updates to chiropractic billing codes, and potential inaccuracies in patient information or treatment documentation. The evolving landscape of insurance policies can also lead to misunderstandings regarding coverage limitations and copayments, complicating the billing process and potentially delaying payments.

Invensis provides expert chiropractic billing services to help practices navigate these challenges by offering tailored solutions that streamline operations, enhance revenue capture, and ensure compliance with the latest industry standards. Our chiropractic billing consultants focus on empowering chiropractic clinics and optimizing their billing processes in the following ways:

• Gathering essential patient demographics, medical history, physician referral information, and complete insurance details, including coverage type, prior authorization status (with effective and expiration dates), and claims address for accurate electronic claims processing.
• Handling the complex process of obtaining pre-authorization for necessary treatments and procedures, ensuring the services are covered by insurance before they are performed, preventing unexpected patient costs, and optimizing revenue capture.
• Integrating digital capabilities such as Electronic Health Records (EHR), Electronic Medical Records (EMR), and Electronic Data Interchange (EDI) into chiropractic-specific billing software to digitize processes from electronic billing to receiving electronic payments.
• Adhering to coding guidelines, documentation standards, and payer policies by managing diverse chiropractic billing models, such as membership or subscription-based billing, cash-based or direct pay billing, etc.
• Staying updated with changes in CMT, CPT, and ICD-10-CM codebooks, as well as E/M codes and HCPCS, to avoid costly coding errors and ensure the assignment of correct codes for chiropractic CPT codes (98940-98942), Chiropractic Manipulative Treatment (CMT), ICD-10-CM diagnoses, and modifiers 25 and 59.
• Deploying accurate billing and coding for various chiropractic techniques—such as diversified techniques, activator methods, Gonstead techniques, etc. to treat conditions like back pain, neck pain, headaches, joint pain, etc.
• Ensuring compliance with evolving regulations and reimbursement structures for all payers, including Medicare, Medicare Advantage Plans, Medicaid, Workers' Compensation, and private insurers like Aetna.
• Streamlining claims submission through automated systems, ensuring timely and accurate electronic claims filing, and continuously tracking the submitted claims for prompt follow-up on unpaid or denied claims.
• Analyzing denial reasons, verifying claims for services rendered, gathering necessary documentation, and resubmitting claims to maximize reimbursement.
• Providing a detailed breakdown of out-of-pocket expenses, including deductibles, copayments, and coinsurance for each service, to help patients understand their financial responsibilities and prevent unpaid claims.
• Generating detailed financial reports that offer insights into billing performance, collections, and revenue trends to identify opportunities for improvement and strategic growth.