Chiro billing in the state of MI

[nancyf]

I have a request from a Chiro practice, they have asked me to analize why they have such a payment gap from what is billed to what is paid.Can anyone provide coding assistance so I may help them bridge this gap? :

[Michele]

There is no real way to assist with what you are asking.  Too vague.  A provider can bill whatever they want, but they only get paid based on RNC & allowed amounts.  For example, I have a chiro that bills $50 for a manipulation and $25 each for two modalities.  So he is charging $100 for a Medicare patient.  Medicare only allows the manipulation at $32.31 so his reimbursement is only 32% of his charged amount.  There is no way to bridge a gap like that.  It is what Medicare allows him to bill.  Are your providers just billing way above the RNC?  Or are they billing codes that aren't allowed?

Michele

[DMK]

I agree with Michele.  You can bill whatever you want, but the insurance companies have a rate they pay, contracted and/or non-contracted.  This amount will differ between carriers as will what is covered and what is not. 

The only piece of advice I can give is to let the doctor know that he/she should NEVER bill just the allowed amount, that get averaged into what all the doctors in the area bill and determines the Usual and Customary allowed for the region. 

For example, we are in northern California in a fairly rural area.  There are still Chiro's charging $15.00 cash per visit.  The insurance companies call around and get pricing, average it, and set the allowed amount.  Blue Cross allows $22.41 for an Adjust 1-2 areas AND Adjust 3-4 areas, $9.17 for modalities and therapies.  We haven't had a raise in the 11 years I've been doing this.  The SFO Bay Area and LA have higher reimbursements.

[nancyf]

Thank you, and Michele do you offer a crash course on Chiro coding?

[Michele]

Not a course, but we do have a book on chiro billing.  NOt sure if it will cover what you need, we don't focus on coding but cover billing chiro as a whole.

Michele

[Sportsmom]

The book they have is a great book I would get it and read over it.
I just took a course from Target Coding and learned alot about coding Chiro.