Chiropractors: Avoid these Common Medical Billing and Coding Errors

Seeing a chiropractor is one of the best ways to save money on medical expenses, particularly for those who have suffered an injury. According to a survey published in the Journal of Occupational Rehabilitation, patients with a workplace injury who see a chiropractor first return to their jobs faster. Even so, many chiropractors are not paid what they are worth, largely due to some common medical billing and coding errors. If you are a chiropractor, here are some practical ways to avoid many of the typical mistakes in your industry.

Obtaining Pre-Approval

Insurance coverage for chiropractic care varies widely from one plan to the next; however, most offer benefits only if you obtain pre-approval. Many chiropractors see patients on a walk-in basis, and would rather not keep them waiting while an associate contacts the insurance company. By seeing the patient anyway, you risk not getting paid, particularly if that person has an active worker’s compensation claim.

Ensure you use Updated Codes

A good number of claims are denied because chiropractors are using outdated codes. The recent switch to ICD-10 resulted in five older codes being deleted and several more being added. In addition, certain modifiers must also be included, particularly when performing manual therapy and an adjustment during the same visit.

Avoid too Much Consistency

If your medical codes never seem to change, this can also be problematic when it comes to getting paid. For example, many chiropractors use the 98942 code for a 5-region adjustment after every visit, or routinely charge for full spine x-rays. A deviation from what is normal in your industry increases your odds of a denied claim, and also makes you more susceptible to an audit.

Learn where your Problem Areas Are

Most chiropractic offices encounter the same problem codes over and over again. Accordingly, one of the easiest ways to eliminate errors is to analyze your data and come up with a list of the most commonly-misused codes. You may discover that you have problems with a particular insurance company, or that certain procedures are reimbursed for less frequently than others. If so, you can tailor your medical billing and coding processes in a manner that helps you avoid these mistakes.

Don’t Under-bill

Many chiropractors fear that billing for every service they have performed will somehow subject them to an audit, and routinely avoid adding codes for reimbursements they are entitled to. Others will forget to bill for periodic evaluations that are often required after six to ten visits. So long as you have the right documentation, you should not avoid using codes for services you legitimately performed. Furthermore, you should develop some sort of tracking system to ensure that periodic evaluations are not overlooked during the medical billing and coding process.
Chiropractors should strive for a denied claim rate of no more than 4%. One of the best ways to achieve that is by partnering with Leeward Medical, as we have a 99% accuracy rate and can therefore guarantee a high number of clean claims submitted the first time.