Chiropractic Care And Insurance Billing: Understanding The Process

Chiropractic billing involves submitting insurance claims to insurance companies for reimbursement for chiropractic treatment services. It can involve private insurance claims, as well as Medicare and Medicaid claims. Chiropractic care is now included in most health insurance plans, although there may be limitations on the number of services covered per person per plan year. To bill insurers and receive reimbursement, chiropractors must establish medical necessity for any treatment provided. This means that any treatment, service, or test must be justifiable as reasonable or necessary based on evidence-based standards of chiropractic care.

Chiropractors can bill insurance companies directly, but out-of-network providers cannot

Chiropractic billing involves submitting insurance claims to insurance companies and getting paid for chiropractic treatment services. Chiropractors can bill insurance companies directly, but only if they are in-network. In-network providers have a contract with the insurance company, which allows them to bill the company directly for their services.

Out-of-network chiropractors, on the other hand, cannot bill insurance companies directly. This means that patients who visit an out-of-network chiropractor will have to pay out of pocket and then submit a claim to their insurance company for reimbursement. This is where a superbill comes in. A superbill is a document that contains all the information an insurance company needs to determine if reimbursement is necessary. It includes the patient's name and information, the practice's name and information, CPT codes for services rendered, and ICD-10 diagnostic codes. The patient then submits the superbill to their insurance company, which will decide whether to provide reimbursement for the services.

It is important to note that insurance coverage for chiropractic treatments typically only extends to the treatment of the spine by manual manipulation to correct a subluxation of one of the vertebral joints. If a chiropractor uses an X-ray or other diagnostic service to find and diagnose the subluxation, the insurance company will not reimburse the cost of the X-ray or extended examination. Additionally, only services referred to as manual manipulation, specifically the use of hands to correct a subluxation of the spine, are covered by insurance.

Chiropractic billing can be a complex and time-intensive process, requiring precision in coding and documentation to avoid claim denials and payment delays. As such, many chiropractors choose to outsource their billing to specialist companies to ensure accuracy and timely reimbursement.

Patients can submit a superbill to their insurance company for reimbursement

Superbills are used for out-of-network billing, meaning they detail services received from a provider who is not within the patient's insurance network. This could be a provider from a different network or a provider who chooses not to accept insurance. Usually, patients pay out of pocket for these services and are then provided with a superbill detailing the services and their costs.

To get reimbursed, patients must file an out-of-network claim with their insurer, who will review the claim and reimburse all, some, or none of the services depending on their assessment. If the claim is not fully reimbursed, patients can fix the rejected parts and refile the claim. Insurers often reject claims for minor errors, so it is worth correcting and refiling.

Superbills are not really bills. They are more like itemized receipts, issued after a service is paid for. They list the patient's name, address, and the costs of their health expenses. Superbills are different from regular medical bills because insurers use them to pay patients rather than providers.

Superbills are sometimes called "encounter forms", "charge slips", or "fee tickets". They are pre-printed documents intended to record the fees connected with a patient visit via procedure codes and any supporting data, like diagnostic codes, that are necessary to bill insurance companies.

A superbill will include the following information:

• Client contact information: name, address, date of birth, phone number, and any unique identifiers requested by the insurer
• Provider information: name, location of practice, state license number, phone number, email address, and National Provider Identification (NPI) number
• Diagnosis: the insurance company needs to know why the client needed mental health services, so a superbill needs to include a diagnosis in the form of an ICD code
• Current Procedural Terminology (CPT) code: used by healthcare providers to describe specific medical and diagnostic services that a patient receives
• Dates of service: the provider should include all dates they worked with the client
• Itemised list of costs: the service amount should be included next to each procedure code, with the total balance reflecting the costs of all services performed
• Referrer identification: the therapist or treatment provider must include the contact information of the healthcare provider that referred the client (if applicable)

The process for receiving and submitting a superbill should be discussed with the insurance company. The easiest method is usually to send the superbill and an EOB through the provider's website document portal, but some companies may prefer fax or mail.

Chiropractic billing involves submitting insurance claims for chiropractic treatment services

Chiropractic billing is the process of submitting insurance claims to insurance companies to receive payment for chiropractic treatment services. It involves billing private insurance companies, as well as Medicare and Medicaid.

Chiropractors can bill insurance themselves, but many choose to outsource this task to a billing company to save time and focus on patient care. Billing companies typically charge a percentage of the claims collected.

The billing process requires precision and a good understanding of the correct billing strategies, codes, and documentation required for each treatment type. Chiropractic CPT (Current Procedural Terminology) codes are a set of five alphanumeric characters that describe the evaluation, treatment, imaging, examinations, and diagnosis services rendered to patients. These codes are used to bill insurance companies, and incorrect coding can lead to claim rejections and payment delays.

In addition to CPT codes, other codes used in chiropractic billing include ICD-10 diagnostic codes and modifier codes, which indicate that a service or procedure has been altered due to specific circumstances. Proper documentation of patient records, including the patient's history, treatment plans, tests, and statements, is essential for accurate billing and timely reimbursements.

Chiropractic coverage typically includes evaluation and management services, radiology, chiropractic manipulative treatment, and modalities and procedures as per the reimbursement policies of insurance companies and Medicare. Medicare, in particular, covers manual manipulation of the spine to correct subluxation, but does not cover certain services such as X-rays, massage therapy, and acupuncture.

Out-of-network chiropractors do not bill insurance companies directly. Instead, they provide patients with a superbill, an itemized document listing all the services provided, which patients can then submit to their insurance company for reimbursement.

Chiropractic care is included in most health insurance plans, but with certain limitations

Chiropractic care is often included in major medical plans such as workers' compensation, Medicare, Blue Cross Blue Shield, Cigna, Humana, Aetna, and UnitedHealthcare. It is also available to active-duty military members, eligible veterans, and federal employees. However, it is important to note that even though these companies cover chiropractic care, their coverage may be limited and subject to certain conditions.

For example, patients may need a referral from their primary care physician stating that the chiropractic care is medically necessary. Insurance plans may also impose a cap on the number of treatments allowed within a month or year, and they may require the use of in-network or approved chiropractors only. Additionally, insurance companies may require the patient's doctor to create and follow an active care plan, and they may not cover maintenance or long-term care plans.

The specific limitations and requirements can vary depending on the insurance provider and the patient's specific plan. It is always recommended that patients check with their insurance company and review their health plan to understand the exact coverage, limitations, and requirements for chiropractic care.

To avoid claim denials, it is important to use the correct billing codes and documentation

Chiropractic billing involves submitting insurance claims to insurance companies and getting reimbursed for chiropractic treatment services. To avoid claim denials, it is important to use the correct billing codes and documentation.

Chiropractic billing and coding require precision as even the smallest of errors can lead to unwanted losses. For instance, billing with incorrect chiropractic therapy CPT codes can lead to claim rejections and payment delays. CPT codes are the codes for procedures performed by a provider during a patient visit. They are created and maintained by the American Medical Association and consist of five alphanumeric characters. There are four main CPT codes that chiropractors use for billing manipulative treatment services:

• CPT Code 98940: Spinal, 1-2 regions
• CPT Code 98941: Spinal, 3-4 regions
• CPT Code 98942: Spinal, 5 regions
• CPT Code 98943: Extraspinal, 1 or more regions

In addition to CPT codes, chiropractors also need to be familiar with ICD-10 diagnostic codes. These codes help determine the type of treatment needed and support the medical necessity of the service. One common ICD-10 code used in chiropractic is "vertebral subluxation," which justifies the performance of a chiropractic adjustment.

To ensure accurate billing and documentation, chiropractors must maintain well-documented patient records. This includes information such as patient demographics, insurance records, diagnoses, procedures performed, and treatment plans. It is also important to establish medical necessity for any treatment provided, as insurance companies may deny claims if they do not deem a procedure medically necessary.

Another important aspect of chiropractic billing is understanding the different insurance plans and their coverage restrictions. Many insurance plans cover a certain number of chiropractic services per person per plan year, but it is important to verify this information beforehand. Out-of-network providers, for example, cannot bill insurance companies directly, and patients will need to submit a superbill for possible reimbursement.

By using the correct billing codes, maintaining thorough documentation, understanding coverage restrictions, and establishing medical necessity, chiropractors can avoid claim denials and ensure timely reimbursement for their services.

Frequently asked questions