Several audits of the claims submitted for chiropractic services have found inappropriate payments. According to a recent report, the Centers for Medicare and Medicaid are continuing to deny chiropractic claims because they fail to meet Medicare requirements. Chiropractic billing services can help providers comply with Medicare and private insurer requirements for coverage, coding, and documentation of services, and avoid improper claim submission.
In addition to loss of revenue, improper chiropractic billing can have dire legal consequences and badly damage the reputation of the practice. In 2015, the US Attorney’s Office reported that an Iowa chiropractor was charged with improperly billing the Medicaid system. The chiropractor denied any wrong doing but agreed to pay $62,349 for alleged improper claims over the period from 2008 to 2015.
The United States Attorney for the Northern District of Iowa said, “This recovery sends the message that health care providers must comply with all applicable state and federal regulations when billing the United States Government for services, or they will face consequences.”
Experienced chiropractic billing experts in a chiropractic medical billing company can help chiropractors understand and maintain compliance with payer requirements for claim submission and get paid appropriately and on time.
According to Medicare auditors, the most common errors related to chiropractic service claims are as follows:
- Lack of specific documentation as required for payment: These include technical errors such as missing signatures and date of service on the claim not found in the beneficiary’s medical record.
- Documentation errors: There may be lack of evidence in documentation that all procedure(s) reported were performed. For example, there may be no documentation or insufficient documentation that all levels of spinal manipulation were performed. Further, the documentation submitted to support the claim may not be sufficient for Medicare auditors to determine the medically necessity of the services provided. Other documentation errors include reporting of maintenance therapy which Medicare does not pay, and reporting of non-covered devices or techniques applied in performing manipulation.
- Initial visit dates absent: A survey by the Office of Inspector General (OIG) found that initial visit dates are not mentioned in the claims, which hinders the identification of maintenance therapy.
Other common chiropractic billing errors include not using modifiers correctly, routine reporting of full spine x-rays and improper use of E/M codes. Starting January 1, 2017, there are several changes to billing Medicare for chiropractic claims. Outsourcing chiropractic medical billing can prevent billing errors and also stay in tune with recent changes. Billing specialists will see that chiropractic claims are submitted with the following information:
- The primary diagnosis of subluxation
- The initial visit or the date of exacerbation of the existing condition
- The Current Procedural Terminology (CPT) code that best describes the service:
98940: Chiropractic Manipulative Treatment (CMT); spinal, one or two regions
98941: Spinal, three to four regions
98942: Spinal, five regions - The appropriate modifier that describes the services
Today, chiropractors can greatly enhance reimbursement by participating in federal programs designed to encourage provision of cost-effective, quality care. ICD-10 coding and participation in the Merit-based Incentive System (MIPS) can help chiropractors achieve these goals. Accurate ICD-10 coding will ensure that claims are reported with the increased specificity needed to measure a healthcare provider’s performance. With reliable chiropractic billing services, chiropractic physicians can take full advantage of the latest ICD-10 codes and enhancements and smoothly transition to the value-based payment environment and enhance reimbursement. These billing specialists are also experts in Medicare documentation requirements and will evaluate chiropractic documentation to minimize their compliance risks and avoid audits and costly paybacks.
Rajeev Rajagopal, the President of OSI, has a wealth of experience as a healthcare business consultant in the United States. He has a keen understanding of current medical billing and coding standards.