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