Recent reports indicate positive trends for the field of chiropractic, the hands-on, drug-free approach to health care. According to the Port Herald, market analysts predicted that the chiropractic care market will grow at a CARG of 3.67% during the period 2017-2021. However, there are many challenges associated with chiropractic medical billing and overcoming these is critical to ensure appropriate reimbursement for spinal manipulation procedures and other treatments.

Chiropractic Care

Chiropractic therapy focuses on aligning the structure of the body, especially the spine, to relieve pain and improve function and to help the body heal itself. According to a study on Chiropractic & Manual Therapies from the US National Library of Medicine National Institutes of Health, the demand for this alternative therapy by older adults is a key factor contributing to the demand for chiropractic care. While spinal manipulation is the primary therapy, chiropractic treatment options for musculoskeletal pain are expanding. With the opioid crisis reaching a high in many states, lawmakers are looking to push for better coverage for this non-drug pain management modality by government and private payers.

A recent www.lanews.org highlights the findings of Persistence Market Research on the chiropractic medicine market. According to the report, the main driving factor for chiropractic treatments is the relief from taking medications. Another factor driving the chiropractic medicine market is the safety of chiropractic treatments compared to other medical treatments such as medications, injections and surgeries for similar conditions, as proven by several studies. Other factors contributing to the growth in demand for chiropractic treatment are:

  • Increasing geriatric population
  • Increasing openness to alternative medicines, and
  • Rise in disposable income

However, the report also notes that the market’s growth may be restricted by several side effects associated with the treatment such as aching or soreness in the spinal joints or muscles and unavailability of services in low and middle income countries.

The report segments the chiropractic medicine market by disease type as: Lower back pain and/or leg pain (sciatica), Neck pain, Repetitive strains, Headaches, Others; and By Age Group: Pediatric, Adults, Geriatric, as well as End Users: Hospitals, Clinics, In Home Consultation, and Wellness Centers. The report also notes that the cost of chiropractic services varies from region to region and by service type. Geographically, the global chiropractic medicine market is categorized into five regions – North America, Latin America, Europe, Asia Pacific and Middle East & Africa. North America has the highest market share in the global owing to the easy access to services and the favorable reimbursement scenario.

While the demand for chiropractic care is increasing, providers need to overcome several challenges associated documenting and billing their services. The key challenges associated with chiropractic medical billing are:

  • As chiropractors treat different injuries and provide various therapies, they need to be knowledgeable about how to bill for these treatments.
  • Chiropractic medical billing rules change frequently, and this poses a major challenge if practices do not have a knowledgeable medical billing service provider.
  • Chiropractors often find it difficult to keep pace with the increased demands of proper documentation associated with ICD-10.
  • Coverage issues: The U.S. Department of Health and Human Services’ Office of Inspector General (HHS OIG) task force’s survey found Medicaid and Medicare were likely to have the highest level of treatment and financial restrictions for chiropractic and non-pharmacological treatment compared to all other payers. The types of chiropractic services eligible for coverage and treatment under Medicare are limited to the following:
    • 98940: Chiropractic Manipulative Treatment (CMT); spinal, one or two regions;
    • 98941: CMT; spinal, three to four regions, and
    • 98942: CMT; spinal, five regions
    • Medicare Part B only covers manual manipulation of the spine if medically necessary to correct a subluxation when provided by a chiropractor or other qualified provider. Medicare does not cover other services or tests ordered by a chiropractor, including X-rays, massage therapy, and acupuncture.
  • Billing requirements vary by payer.
  • Other billing challenges for chiropractors include: use of modifiers, incorrect payments, and incorrectly reduced codes.

Difficulties associated with providing different therapies and handling associated patient issues within a tight schedule leave chiropractors with less time to focus on billing and documentation. The number of Medicare audits of chiropractic offices has continued to be high in the past decade and is expected to grow. The In 2016, the HHS OIG audit found that the the Improper Payment Rate for chiropractic services was 46.0%. The OIG reported that the Improper Payment Rate of chiropractic Part B Medicare claims was the highest of any Part B service type in both FY 2015 and FY 2016. The Centers for Medicare and Medicaid Services (CMS) noted that 98.4% of the chiropractic claims were denied because of lack of documentation or insufficient documentation.

It is clear that for appropriate reimbursement for manual manipulation services, providers should ensure that their documentation practices fully comply with Medicare and their MAC’s requirements, including local coverage determinations (LCDs). Partnering with an experienced chiropractic medical billing company is the best way to ensure accurate coding and billing of services. Reliable outsourcing companies will check claims before they are sent out to ensure that documentation meets medically necessity and regulatory requirements, and whether all services are properly and fully documented.