With Medicare and private payer insurance changes and new requirements and regulations, chiropractic medical billing has become quite complex. In this dynamic scenario, chiropractors need to revamp their revenue cycle technologies and billing workflows to submit clean claims, reduce denials, and get reimbursed. Here are seven chiropractic billing strategies that can streamline a practice’s financial workflow and improve revenue.
- Educate patients: Patients are facing higher deductibles and co-pays higher than ever before, but most are unschooled in these aspects and other chiropractic medical billing and insurance terminology. With patients being more responsible for their own healthcare costs, it’s important to initiate conversations with them about cash. A recent JAMA Internal Medicine study found that the percentage of hospitals that are not able to give consumers price estimates increased from 14 percent in 2012 to 44 percent in 2018. According to a Revenue Cycle Intelligence report, to improve the patient financial experience, providers should inform patients of their financial responsibility before their office visit. Patients should understand the costs involved with chiropractic care, what their insurance covers, and what their financial responsibilities could be. A Medical Economics article suggests that patients be given a flyer with a simple explanation of billing basics. They can be directed to a customer service number for issues that need clarification. Make sure office staff knows how to communicate with patients about billing information.
- Verify insurance: Billing success begins at the front desk. Insurance verification should be done at each visit to understand what the patient’s responsibility is. Carriers offer different plans with varying deductibles and copay options. Getting insurance eligibility verification done by a specialist before the office visit would ensure that both the provider and the patient know how much the patient is responsible for and what’s covered. It’s important to check eligibility for returning patients who have been absent a while. Recording accurate patient data, including insurance information and provider eligibility, is necessary for error-free claims submission.
- Analyze and optimize accounts receivable (A/R): “Days in A/R” refer to the average number of days it takes to collect the payments due to the practice. The lower the number of days, the faster the practice is obtaining payment, on average. Physicians Practice recommends keeping your accounts receivable in the 0-30 day category. Evaluating A/R will help you determine whether your practice’s revenue management cycle processes are efficient and effective, and address any issues preventing timely payments. Here are some tips to optimize A/R management:
- Separate insurance and patient accounts receivable
- Understand how each payer’s specific guidelines affect your A/R management
- Establish relationships with each payer as this can help resolve problems faster
- Analyze reimbursement trends by payer on a monthly basis to identify, evaluate and prioritize the risks
- File claims on the day of service
- Implement a strict collections policy for patient accounts
- Even if you have a medical billing company handling your revenue cycle management, chiropractors need to maintain constant awareness to manage their A/R processes.
- Review insurance contracts: Practices need to take time to review their contracts with payers to understand if there were any changes from the previous year. This will allow them to take steps to plan for any renotiations, accommodate a change in workflow and processes, and retrain staff if necessary. Providers should also be aware of all filing deadlines for the year ahead.
- Code correctly: Clean claim submission depends to a large extent on accurate coding. With ICD-10, chiropractors can use more specific codes to report diagnosis and using the right codes can prevent claim denials and ensure appropriate reimbursement. They must also use the right chiropractic procedure codes and modifiers to report services rendered correctly. Incorrect coding will attract unwanted scrutiny and also affect revenue.
- Ensure appropriate documentation: Among the four major types of documentation errors (no documentation, insufficient documentation, lack of medical necessity, and incorrect coding), the Department of Health and Human Services Office of Inspector General (OIG) found that improper payment rates attributed to insufficient documentation rose from 39.5% in 2010 to 92.2% in 2014 (www.chiroeco.com). Each patient encounter should be clearly documented to prove that the service was actually performed.
- Collect copays: To collect copays, have an established financial policy in place. Patients should sign a form acknowledging that their insurance may not cover all of their care. They can be offered flexibility and payment options to facilitate payment for all services and products as and when they are provided.
Practices that find it difficult to streamline their revenue cycle management can rely on an experienced chiropractic medical billing company to do so. Using the practice’s billing software or their own, an experienced outsourcing company can help chiropractic practices streamline their financial process and improve their revenue.
Julie Clements, OSI’s Vice President of Operations, brings a diverse background in healthcare staffing and a robust six-year tenure as the Director of Sales and Marketing at a prestigious 4-star resort.