Medical Billing Forum

General Category => New! => Topic started by: ste on August 17, 2016, 01:32:23 PM

Title: Specialists cannot bill specialties
Post by: ste on August 17, 2016, 01:32:23 PM
Insurance has come up with yet another ploy to reduce payouts. Policies are being written as office visits only. For example, chiropractors cannot bill manipulations but can bill office visit codes and modalities. To you and I it may seem simple not to bill certain codes but ask a 20 year veteran not to bill chiro codes becomes a hair pulling experience.
Title: Re: Specialists cannot bill specialties
Post by: Michele on August 18, 2016, 08:53:39 AM
Is this a particular insurance carrier or across the board?  We haven't run into this yet.
Title: Re: Specialists cannot bill specialties
Post by: kristin on August 18, 2016, 08:31:51 PM
I haven't encountered this issue either. Then again, I don't bill for chiro.
Title: Re: Specialists cannot bill specialties
Post by: ste on August 18, 2016, 10:36:44 PM
Moda is the insurance and chiropractors and acupuncturists are the victims
Title: Re: Specialists cannot bill specialties
Post by: PMRNC on August 19, 2016, 12:45:09 PM
That is a limited thing.. YES there are plans structured by "tiers" with copay's.. some only paying on "office visits". It really isn't something that is the norm and these are limited plans. It is very important when verifying benefits to find out if the plan is a "co-pay" tiered plan. There are also some indemnity plans that have been doing this for a while.. but again, they are few and far between.  This is one of reasons I don't use a verification system and do all my verifications manually via phone..there are just too many variables even with the ACA in determining eligibility and benefits. For example, you may not get the fact that a plan is a grandfathered plan via any eligibility systems.