Author Topic: Help with Chiropractic Clients  (Read 1579 times)

dfranklin

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Help with Chiropractic Clients
« on: August 20, 2010, 05:10:27 PM »
Anyone out there doing billing for Chiropractors? I know it is not the ideal specialty to have as a client for many reasons but I do have a few and was wondering if anyone else has any as clients. If so how do you handle the denial managment for them?

Chiros tend to have ALOT of denials just because of the type of provider they are and it can get OVERWHELMING. Just one of my clients has between 600-900 insurance claims a month and each claim may have between 3-9 service line items. Many of them are denied (legitimtately) but trying to wade through all of those to find the ones that need to be corrected and resubmitted or appealed etc is a difficult task.

Calling carriers on all of the outstanding claims is an even tougher task due to the volume. Many of the claims are PI (Personal Injury) so claims are going to liability companies like state farm, Progressive, etc and they don't have automated systems and take alot of man power to call on all of those.

I would love to hear back from Anyone with help or suggestions in this area.

Thanks!

Michele

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Re: Help with Chiropractic Clients
« Reply #1 on: August 21, 2010, 09:56:48 PM »
We actually bill for several DC's and often have wondered if they are profitable.  They have high denial rates and low allowances.  The only advice I can give is to make a 'cheat sheet' of what is covered and by what carriers.  That way you have a reference to go by when reading the eobs.  That will eliminate calling on ones that are processed correctly.  As for outstanding claims, we run aging reports every 4-5 weeks and call on all claims that should have been paid.

Michele
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dfranklin

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Re: Help with Chiropractic Clients
« Reply #2 on: August 24, 2010, 02:50:49 AM »
How would you go about creating a cheat sheet for that?  You basically would have a list of regularly used CPT codes then for each insurance put in the allowable? Do you have an example of something I could reference?

What about when the same carrier states a code is allowed for one member but then not for other members (they have different coverages)...or I have seen where somehow the carrier has said it was not medically necessary (not sure how they determined that just off of the DX codes becuase they don't have the notes or anything). I am talking about major carrier like Highmark BCBS etc....let alone the other smaller carriers.

Michele

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Re: Help with Chiropractic Clients
« Reply #3 on: August 24, 2010, 09:23:28 PM »
We have folders for each of our providers that the work goes into when it comes in.  The folder has notes on the outside, and sometimes on the inside, that contain any information that someone who was going to do the work would need.  For example, if we know that Highmark only allows the manipulation and doesn't cover the modalities, we will put that on a note on the folder so that when you are inputting eobs you know you don't need to call on that.  We have seen BC policies that one will allow something that another policy does not cover.  We just start with the first thing we discover and keep adding to the notes.  It's not easy, but it helps.  Whenever we get something where they deny and it isn't logical (not med nec when they don't have notes) we call and ask for an explanation.  If it make sense, fine. Otherwise we appeal the denial.

Michele
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DMK

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Re: Help with Chiropractic Clients
« Reply #4 on: August 25, 2010, 10:45:27 AM »
Great advice Michele!  Chiropractic is tough and getting tougher all the time!  I've been at it for 11 years and it changes every year.

Each Ins. Co. is different so it's important for the Dr.s' offices to verify benefits. Some only allow a limited number of therapies/modalities p/visit.  Some disallow certain therapies all together. For example:

       1. Medicare ONLY allows spinal adjustments.  No extremities, no therapies, no modalities, an exam is required, but they won't pay for it.  Your ABN should outline this, and if you use the correct modifiers, you can bill the patient for it.  Some secondaries cover the extras, supplementals only cover Medicare allowed items.  Medicare has SPECIFIC diagnosis codes for billing to support medical necessity.

       2. Blue Cross has MANY plans with different benefits, their web site is good though for finding out coverage.  Be sure to use -59 for therapies and modalities to indicate a separate service, and -25 when billing for exams that are for new patients and new dates of injuries (otherwise the exam is bundled as being part of the adjustment.

On a side note for Blue Cross, ASHN is the governing body in California, if you must get authorization for treatment, read the authorization!  They often state that only 1 therapy/modality is allowed per visit.  If your doctor is having the patient get massage, they only pay 1 unit at $9.17.  When they request authorization they need to outline that they are prescribing massage and a certain # of units depending on how many areas are being worked on.

     3. Blue Shield has their computers automatically reducing therapy/modality units to 1.  I have to rebill our massages (usually 1 hour, 4 units) with treatment notes to get it paid.  Sometimes they pay, sometimes they don't.

     4. Aetna only allows 3 therapy/modalities per visit.

     5. Worker's comp has the cascade, and you will "time out" with too many therapies/modalities.

     6. PI was the ONLY 100% payment.  And now the auto insurance companies have contracted with certain insurance companies so we're starting to get cut to U&C more often.


On a personal note, the difficulty we have is due to the "greedy" docs out there.  Don't get me wrong, they are the minority!  But the practice management seminars teach them to bill everything but the kitchen sink and the trickle down is that the insurance companies clamp down on all of us.  This is the #1 reason for all the cuts.  It's why more and more chiros are going to all cash practices, and more insurance companies are trying to carve out chiropractic.  Fortunately, there are people out there fighting for patient's rights to use chiropractic for their healthcare.  It's a heated discussion in a field that is very dogmatic!

I hope some of these observations help reduce your frustration.  It's important, too, that your docs understand WHY the changes are happening so they can police within their own specialty!

Dina

dfranklin

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Re: Help with Chiropractic Clients
« Reply #5 on: August 26, 2010, 08:35:22 PM »
That helps a lot!!!

Thanks guys! I really appreciate it...

Don