The A-Z of Chiropractic Medical Billing and Coding

Chiropractic is a form of alternative medicine that deals with disorders of the musculoskeletal system. There are more than 70,000 chiropractors registered in the United States, and annually, the number of people visiting chiropractic clinics crosses 35 million!

Chiropractic medical billing and coding can be slightly more challenging than the other healthcare segments for the following reasons.

  • The legal restrictions for chiropractic treatments are different.
  • Medicare and Medicaid chiropractic coverage varies across different states.
  • The inclusions and exclusions for chiropractic insurance coverage keep changing.
  • Billers may need to send primary, secondary, and tertiary claims to reimburse bills.

If you run a chiropractic clinic, you must balance both ends equally – the treatments as a chiropractor and the business as an entrepreneur. One of the biggest challenges that chiropractors face is billing.

Depending on the state you practice out of, there may be certain limitations in the services that can be covered under insurance. Many chiropractors don’t accept insurance because they cannot handle the hassles of reimbursements later on.

However, accepting insurance payments is the first step if you want your service to grow. Here are the reasons why.

  1. The fact that you accept insurance payments may encourage more people to try out chiropractic services, ensuring you have a good ratio of existing to new patient intakes.
  2. Accepting insurance payments helps patients in pain get the proper treatment at the right time.
  3. Becoming an in-network chiropractic clinic will also help your services spread through word of mouth.

If you want to start accepting insurance payments and become an in-network practice, then the first thing to sort out is your existing medical billing and coding practices.

Many chiropractors try to get billing done with the same administrative staff they have hired for other front desk operations. This may not be very effective.

There are two ways you can handle medical billing and coding. – in-house and outsourcing.

In-house medical billing and coding require hiring billing and coding experts to work for you full-time. They will take over the billing process, create codes and send them to the insurance companies for reimbursements.

This can work if you are a busy practice and can afford to pay full-time for billers and coders. If not, then outsourcing may be the smartest choice here.

When you outsource medical billing and coding to companies like Quintessence, we study the existing process, get in touch with your team, and devise a plan that would work for both of us. Our contingency-based fee model has helped many practices in their beginning stages to afford quality billing and coding and grow.

Quintessence always considers ourselves as partners and not just service providers. As a result, we work on your holistic RCM operations improvement and ensure SLAs are met from day one.

Another advantage you will get by outsourcing medical billing and coding is the exceptional quality of service and unchallenged industry experience. Let’s consider our team, for instance. Our billers, coders, and other team members have an overall work experience of 100+ years in the medical billing and coding industry.

When you hire us, this combined experience and expertise will be available.

Since our core strength is RCM services, we have consistently invested in intelligent technology and AI-based tools throughout our existence. These work for you, too, reducing the A/R cycle, bringing down denial rates, and improving reimbursements.

Precise and error-free coding is essential to support the chiropractic billing process. This needs to be nailed every time because the insurance companies check the codes to process reimbursements.

If the codes are wrong or incomplete, the claims would either be paid partially or denied altogether. For chiropractic services, the CPT codes range between 98940 – 98942. The codes will vary depending on the area in the body treated and the number of regions covered through treatment.

If your coder uses one code instead of the other, the extent of treatment offered may be misinterpreted, and your final reimbursements would be affected.

The medical billing and coding team you choose also needs to handle documentation, which is often one of the ongoing steps determining the final bill created. Documentation includes all of the below.

  • Pre-manipulation assessment
  • Response to treatment
  • Further physical improvements/deterioration
  • The outcome of the treatment
  • Plan for ongoing treatment

Now, insurance companies require all these documents to be in place, so the claims can be processed and reimbursed. Your documentation and the billing and coding team need to work hand-in-hand so that this happens in a coordinated manner.

Another challenge to chiropractic services is knowing the ‘limits of service.’ What is this?

Since chiropractic services are not a part of regular healthcare services and are considered alternative medicine, different states have different limits for insurance coverage.

If you are a small service based out of a single state, medical billing and coding may be easy, and the limits can be learned over time. What happens when you expand to a new state? How will your centralized billing and coding team handle your practice when your function out of multiple states?

This is where you need experienced billing and coding teams to assist you. Quintessence understands this unique challenge of chiropractic services, which is why our team specializes in handling all techniques and sub-services offered by chiropractors across the country, including the following.

  1. Primary chiropractic investigations and treatment
  2. Diagnostic practices that are a part of primary chiropractic services
  3. Chiropractic healing techniques and services
  4. Straight and mixer practices
  5. Supportive medical techniques, including massage or ice therapy
  6. Sports chiropractic specialty techniques
  7. Nutrition and fitness training techniques
  8. Physical rehabilitation

As a chiropractor, treating people and helping them live pain-free will be your number one priority. Quintessence can be your backend support partner that takes care of administrative burdens and revenue cycle management operations smoothly and precisely. At the same time, you can focus on treating people and growing your brand.

Medical billing and coding processes don’t have to be burdens anymore. When you get them right, they will support your financial state and help your practice get new patient intakes over time.


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