Introduction to Chiropractic Billing Services

Before diving into the medical billing for chiropractic services provided by the healthcare providers, knowing what chiropractic adjustments are is also important. The specialists align the spinal cord by applying pressure to the vertebrae to improve the overall body posture. When we talk about Chiropractic Billing Services to get compensated for the healthcare services provided to the patient, the medical biller must understand and have a vast knowledge of terminologies related to chiropractic conditions. Making the decision to hire a medical billing specialist is a very crucial one. There are many factors to consider, as their experience, knowledge, and understanding of chiropractic manipulations chiropractic billing modifiers, and CPT codes.

How do you bill for chiropractic medical services?

Using the right CPT Codes and Modifiers is crucial for preparing a clean medical claim for chiropractic services provided by the practitioner. Each healthcare service or procedure has a specific CPT code. Now in order to get compensated, you must use the specific chiropractic modifier and CPT codes.

Chiropractic CPT Codes:

When preparing a medical insurance claim, A CPT code is used to report the medical procedure, service, surgical, or any diagnostic test that is being performed. Medical billing and coding involve the physician, insurance payer, and the patient.

CPT stands for Current Procedural Terminology codes. These codes are used to report the medical procedures or services provided by the healthcare provider, in this case, the chiropractor. Accuracy is essential when it comes to inputting the CPT codes to get compensated for the services provided. In case of wrong codes, the claim gets rejected or denied resulting in late payments and a lower reimbursement rate. Following are four of the most essential and common codes used when billing for chiropractic services:

1. 98940 (CMT):

This chiropractic billing code includes examining, diagnosing, and providing chiropractic manipulations involving one to two spinal regions.

2. 98941 (CMT):

It includes examining, diagnosing, and providing chiropractic manipulations involving three and four spinal regions

3. 98942 (CMT):

It includes examining, diagnosing, and providing chiropractic manipulations involving five or more spinal regions

4. 98943 (CMT):

It includes providing chiropractic manipulations to extraspinal regions (one or more).

Note: CMT stands for Chiropractic Manipulative Treatment.

Modifiers for Chiropractic Medical Billing:

When we talk modifiers in chiropractic billing services, there are a number of modifiers being used today. The key is to know when a specific modifier can be used and when it can’t be. Among those, the two most commonly used modifiers in chiropractic medical billing include:

1. Modifier 25

This modifier is used to report any E/M service (Evaluation and management service) that the same healthcare physician is independently recognized and performed on the same day. Note that this type of modifier (25) is only applicable for Evaluation and Management Services (E/M).

2. Modifier 59

The most commonly used non-E/M service code used by chiropractors is 97140 (Manual Therapy Techniques). This code requires modification, which can be done using modifier 59 in medical coding. Any separately recognizable non-E/M (Evaluation and Management service) performed by the same physician on the same day is reported under modifier 59.

Chiropractic Billing Guidelines:

When it comes to chiropractic billing services and using a specific code and modifier, CMS defines specific guidelines (Centers of Medicare and Medicaid Services).

The guidelines for chiropractic billing services include the following: –

– The medical claim must highlight:

o   Precise level of subluxation as the primary diagnosis

o   Neuromusculoskeletal condition (the reason behind the treatment) as the secondary diagnosis.

– The medical claim for chiropractic manipulative treatment must include the following details:

o   Initiation date for the treatment

o   Codes including:

• Procedure code
• Secondary Diagnosis Code (s) / Diagnosis/ Symptom
• Primary Diagnosis Code (s) / Subluxation

o   Date of service

O Place of service

Note that if any of the information mentioned above is incomplete, it can result in claim denial or delay.

– According to CMS, rules of Limitation of Liability apply when billing for chiropractic services. (This helps protect the beneficiary in the denial cases (from any liability) where the healthcare services provided by the physician are categorized as not medically necessary).

– The chiropractor must have a documented file of the following details:

o   Exact spinal location

o   The level of subluxation

• The physician must sign Hand-written or electronic prognosis reports or notes.

Note: if you want to request a review in case of denied chiropractic service, the medical necessity must be proven by submitting proper documentation supporting the denial. 

Challenges in Chiropractic Medical Billing:

Every healthcare specialty faces a number of challenges regarding medical billing and coding same goes for chiropractic medical billing. Following are some of the most common challenges faced by practitioners in chiropractic billing services:

1. Billing Conditions:

Insurance payers are very keen on the details of medical procedures and the practitioners’ services. Chiropractic medical billing is a complex task which is why it requires to be done by specialists as even a minor mistake can lead to denials.

2. Being updated about the rules and regulations:

Since COVID-19, various healthcare guidelines have faced drastic changes and this constant change in guidelines means more training. The medical billers need to keep up with all the regulatory changes and adapt accordingly so their claims don’t get rejected or denied.

3. Medical Billing Systems:

Chiropractic healthcare providers need to opt for advanced billing software with all the drastic changes. This results in chiropractic providers leaning towards outsourcing their medical billing services and revenue cycle management in the hands of professionals.

 Tips for avoiding errors and boosting chiropractic revenues: –

Use of wrong modifiers or CPT codes when billing for chiropractic manipulation services results in claim denials, late payments, and lower reimbursement rates. Following are some of the tips to boost revenues and avoid errors in chiropractic medical billing: –

– Verification: –

Incorrect or incomplete patient information and related medical data can result in claim denials, so accurate verification of complete patient information required by the insurance provider are essential.

Make sure that the medical claim includes accurate and complete patient insurance information and medical data.

– Managing claim denials: –

Revenues are essential to keep the practice running. Without them, you can be at risk of losing it all. Errors lead to denied claims, affecting the revenue cycle and reimbursement rate.

Therefore, if your medical claim gets denied, analyze and identify the errors and manage the denied claims accordingly. Figure out the reason behind denial, whether it’s the wrong name, wrong spelling, or any other details about the beneficiaries.

– Medical Billing and Coding Experts: –

With a team of expert medical billers and coders, your practice will have fewer medical claims errors, a higher reimbursement rate, and an improved revenue cycle.

– Using the right chiropractic codes: –

The most commonly used chiropractic CPT codes are mentioned above. Using these codes accurately is essential. Use the right codes for your practice to avoid denials and increase your revenues.

– Send clean medical claims: –

A clean claim is a claim with zero errors and correct and complete information with timely submissions. Sending a clean claim results in a lower denial rate and the higher clean claim rate, therefore an improved revenue cycle.

Considering all the tips mentioned above, outsourcing your services to a medical billing company is the most effective way to boost the revenue cycle for chiropractic medical billing. You get many benefits by outsourcing your billing services to a company like UControl Billing.

There is one question that might arise, Like Why Outsource?

Here’s why outsourcing chiropractic billing services is a necessity:

Medical billing companies like UControl Billing have an expert team of medical billers with the main focus to reduce errors and increase the reimbursement rate for your chiropractic service. They have state-of-the-art billing software and are updated regarding any changes in rules and regulations for medical coding and documentation guidelines.

Outsourcing your medical billing and coding services helps in improving the revenue cycle and increasing the reimbursement rate.

Benefits of Outsourcing Chiropractic Medical Billing Services:

When it comes to outsourcing medical billing services for chiropractic manipulations, there are a number of benefits. Following are the benefits:

• Billing Compliance Improved:

With outsourced medical billing services, you get improved billing compliance. In simple words, it means that the medical billing is done according to the rules and regulations of the state. This helps prevent abuse or fraud. With in-house medical billing, the healthcare provider must be up to date and compliant with the regulations.

But with outsourced medical billing, the companies are well aware of all the recent changes and amendments in the regulations and adapt accordingly to avoid denials. Along with this, their experience also helps them detect any such activity.

• Higher Reimbursement Rate:

Medical billing and coding are not as simple as they might sound. It involves various steps before the complete process is done; submitting a clean claim is just the start. Often medical claims get rejected or denied, to which medical billers have to follow up on, figure out the errors and resubmit the claim. This requires continuous communication with the insurance payers to compensate the practitioner for the medical service they provide. All of this can be really time-consuming and hectic for an in-house medical biller.

Whereas there is a lesser rate of errors and faster reimbursements with outsourced medical billing. They are well informed about the payer’s requirements; the team of expert medical billers contact the insurance payers and get the work done in time.

• Effective Management of rejected or denied claims:

Managing the claim denials and rejections is another crucial step in medical billing. As mentioned earlier, timely follow-ups with the insurance payer are necessary for resolving the denied claims.

Medical billing company has a huge workforce to manage and monitor the status of a denied claim and resolve it in time so that the healthcare provider is compensated for their services.

• Timely Follow-ups and reporting:

By outsourcing your medical billing services to a company like UControl Billing you get timely follow-ups and regular reporting. This reporting helps the chiropractors be informed about their revenue cycle, reimbursement rate, and financial situation. Based on this chiropractic healthcare providers can focus on improving their operations and healthcare facilities.

• A highly specialized and updated team of medical billers: –

Even minor medical coding and billing errors can result in claim denials, low reimbursement rates, and lost payments. By outsourcing your chiropractic medical billing and coding services, you get a specialized team of expert coders and billers with a primary focus and goal to increase your revenue cycle. To avoid errors, they are well aware of all the billing and coding guidelines, documentation guidelines, and coding updates.

UControl Billing offers you end-to-end RCM (revenue cycle management), a higher reimbursement rate, faster payments, and lower errors.

 Why UControl Billing?

With our renowned medical billing and coding services and solutions, we have built a reputation worthy of aiding you to grow and build a profitable healthcare practice. With the primary focus to prepare clean claims, increase your reimbursement rate, and improve the revenue cycle.

Our team of expert medical billers and coders handles all of the crucial areas related to medical billing, so you don’t have to worry about the administrative tasks and focus on your primary cause. Our team handles everything from creating clean claims to submission, managing claim denials and timely follow-ups, payment posting, and reporting.

Medical billing and coding are crucial areas for running any medical practice and we aim to increase your revenue collections in time. Following are the services offered by UControl Billing:

– Medical Billing services

– Medical coding Services

– Revenue Cycle Management (RCM)

– Front Office Management

– Telemedicine Billing Services

– Medical Transcription Services

– Medical Credentialing Services

– Value-Added Services like

•         MIPS MARCA & Eligibility
• ·         Medical Billing Reports

Touseef Riaz

A couple of years ago, I executed the effective plan of creating a Medical billing and Coding company named U Control Billing. The company aims to bring revolutionary advancements to foster medical billing and coding revenues. As an official member of HIA-LI and MGMA, I feel honored in providing networking opportunities, problem-solving, and improving the revenue management cycle.