Chiropractic is one of the specialized procedures performed on the patient, usually the treatment is restricted only to a certain part, complicating the billing process. If the chiropractic process is billed under Medicare, we would see further coverage limitations. Medicare service extends only for the treatment of spine by manual manipulation to correct subluxation for one of the vertebral joints.

Chiropractic claims need to be supported by documentation, using Legion Healthcare Services (LHS) billing experts, chiropractors can synchronize patient care and document management. The restricted reimbursement of chiropractic procedures makes the need for chiropractic billing experts imperative.

“Chiropractic billing has been one of the most complicated billing procedures, the constant updates by Medicare for the billing process and number of procedures which are either covered or not covered. With a private insurance company, we deal with different process where we contact them whether the procedure is supported or not.”

– a Billing Manager for Chiropractic RCM Process

To make the patient and chiropractor relations better, LHS recommends implementing in-patient service for the maximum number of patients. The in-patient service can be expanded with physician credentialing which would even assist in growing the service further.

Patient Verification

Verify patients' benefits, if the required procedure is covered and if not, what will be the patient's contribution. Collecting the information up front will reduce the claim denials and make you keep the information open with client. Legion has a list of requirements before any billing process begins such as certain sessions are only covered with referral, certain sessions may require prior approval for service.

Patient Documentation

Keeping patients' chart notes should be specific and detailed. LHS documentation experts suggest that before any chiropractic procedure following info should be submitted: Need for treatment, objective of treatment, measuring the client progress, the overall treatment still required, and complete treatment. Such documentation will help make sure the insurance company can track the progress of the client and avoid unnecessary scrutiny.

Caution for Coding

Legion medical coders have experience in dealing with several insurance companies that have a different level of audit process. For chiropractors to be paid, coding is the basis that will drive the claim. Currently, four main codes are used in Chiropractic billing:

  • CPT Code 98940: Chiropractic manipulative treatment (CMT); Spinal, 1-2 regions.
  • CPT Code 98941: Chiropractic manipulative treatment (CMT); Spinal, 3-4 regions.
  • CPT Code 98942: Chiropractic manipulative treatment (CMT); Spinal, 5 regions.
  • CPT Code 98943: Chiropractic manipulative treatment (CMT); Extraspinal, 1 0r more regions.

A team of certified coders to work with chiropractic documents along with assessment forms.

Support for EHRs is provided by all billing managers to improve chiropractic automated data collection.

Analytical data support for all account receivables to improve revenue. Denied claims are managed by billing managers to improve the AR percentage for them.