Insurance companies didn’t cover chiropractic services, because they thought the treatments unnecessary and experimental. So Chiropractic Medical Billing has only evolved over the last decade.
Nowadays, however, chiropractic services are more commonplace. Many insurance plans cover a certain number of chiropractic services per person per plan year, in other words, service limits or restrictions.
Probably the greatest restrictions would be the coverage limits. Insurance coverage of chiropractic treatments simply extends by manual exploitation to treatment of the spinal column, to correct a subluxation of the vertebral joints.
In the event the chiropractor uses an X-Ray or other diagnostic service diagnose and to discover the subluxation, the X-Ray or examination may be used for additional documentation.
All other services the chiropractor supplies are considered non-insured by Medicare, which establishes the precedent for many commercial insurance providers.
So chiropractic medical billing specialists are needed to fill out medical claims forms, complete with diagnosis and procedure codes, and send them to insurance companies for payment. Just like any other medical claim.
There are lots of restrictions on chiropractors because their services are so specialized. As such, there’s a very specific set of codes that chiropractic medical billing specialists can use.
The following guidelines are set forth by CMS, and are used for billing Medicare. If you’re billing for other commercial insurance plans, there may not be as many restrictions as those listed here.
Chiropractic Coverage Restrictions
If chiropractic claims aren’t billed correctly (with documentation of medical necessity) then they won’t be considered or paid for by the patient’s insurance company.
Perhaps the biggest restrictions are the coverage limitations. Insurance coverage of chiropractic treatments only extends to treatment of the spine by manual manipulation, to correct a subluxation of one of the vertebral joints.
If the chiropractor uses an x-ray or other diagnostic service to find and diagnose the subluxation, the x-ray or exam can be used for further documentation.
However, insurance won’t reimburse for the use of an x-ray machine or for the extended examination.
All other services that the chiropractor provides are considered non-covered by Medicare, which sets the precedent for many commercial insurance companies.
This means that anything performed by the chiropractor, other than the spinal manipulation, won’t be paid by the patient’s insurance company.
What is Manual Manipulation?
Only services referred to as manual manipulation are covered by insurance.
More specifically, this is limited to the use of hands to correct a subluxation of the spine. In other words, the chiropractor uses his hands to help realign the patient’s spinal column.
Manual devices which provide an additional thrust or force are also allowed as part of the covered definition of manual manipulation. Even though they’re allowed, CMS doesn’t allow an additional payment for the use of the device.
Sometimes, the word correction is used in place of treatment. Both are covered if they’re part of the manual manipulation. Here are some other terms that indicate manual manipulation:
- Spinal adjustment by manual means
- Spinal manipulation
- Adjusted manually
- Vertebral manipulation/adjustment
To understand how to bill chiropractic medical billing claims, you have to understand the vocabulary.
Definition of Subluxation
A subluxation is when the alignment, movement integrity, or physiological function of the spinal joints are altered, although contact between the joint surfaces (of the vertebrae) remain intact.
In other words, your back is out of place. This spinal maladjustment can cause many symptoms, including:
- poor posture
In order to get reimbursed by insurance for chiropractic services, the exact location of the subluxation must be clearly noted in the patient’s medical chart. These locations range from the occiput vertebrae in the neck to the sacral vertebrae and coccyx.
You can specify the subluxation by referring to the exact bones that are out of place, or by referring to a certain area or set of vertebrae that are out of place.
There are also other terms that also indicate subluxation, including:
- Incomplete dislocation
- Abnormal/altered/decreased/increased spacing
What is PART of Chiropractic Subluxation
To demonstrate a subluxation by physical exam, there are four criteria to choose from:
- Pain/tenderness in a specific location, of a certain quality, or of a certain intensity
- Asymmetry/misalignment of a sectional of segmental level
- Range of motion abnormality
- Tissue or tone changes in soft tissue
The patient must demonstrate at least two of these four symptoms. One always has to be either asymmetry/misaligned or range of motion abnormality.
These four factors (acronym PART) are the basis of all chiropractic physical exams.
In addition to the stringent demands set forth by the physical exam and description of the subluxation, there are two other criteria that must be met in order for chiropractic services to be covered. They are:
- The patient must have a significant health problem which makes it necessary for the chiropractor to use musculoskeletal manipulation as a therapeutic remedy
- The patient must have a spinal subluxation, as determined by the physical examination or x-ray.
If both of these conditions aren’t met, then the chiropractic services won’t be covered.
Additional Chiropractic Medical Billing Guidelines
CMS goes on to include many more rules and guidelines which determine whether or not chiropractic services will be paid for.
Example: chiropractic maintenance therapy, for the prolonged maintenance of a subluxation or for non-medically necessary therapeutic use, isn’t covered in any circumstance.
There are also further guidelines for the use of dynamic thrust (the technique used by most chiropractors to correct subluxations), and the frequency of chiropractic manipulations.
Preferred Health Resources offer a three-dimensional sphere of medical billing specialties that provide comprehensive support for the busy physician or surgeon whose practice demands his or her attention 24 hours a day, seven days a week. In addition to professionally and accurately submitting all your claims, Preferred Health Resources also provides the following services for one, performance-based fee:
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- Evaluation and recommendations for fee structuring strategies
- Over 1,200 different type of reports are available to all practices
The intricacy of chiropractic practice bill is growing. Your practice wants routine and highly accessible use of an account representative that understands your practice inside out. You and you ought to anticipate your bill service customer support section and immediate accessibility, respectively in the event of crises.
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- Assignment of a personal account executive
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Experiencing significant loss of revenue due to billing issues is both unnecessary and rectifiable. PHR’s experienced staff of authoritative medical billing and claims processors are always prepared to fight for its clients to get the best reimbursements from all carriers. Let Preferred Health Resources take charge of the medical billing aspect of your cardiology practice and discover the satisfaction of knowing your claims are being managed accurately, professionally and with a personal touch.
For a Free Consultation Call
If you’re a chiropactor searching for a medical billing firm that improves your reimbursements you should call PHR. Preferred Health Resources does medical billing for chiropractic services that are customized for you, your office and patients.
Experiencing significant loss of revenue due to billing issues is both unnecessary and rectifiable. PHR’s experienced staff of authoritative chiropractic medical billing and claims processors are always prepared to fight for its clients to get the best reimbursements from all carriers. Let Preferred Health Resources take charge of the medical billing aspect of your chiropractic service and discover the satisfaction of knowing your claims are being managed accurately, professionally and with a personal touch.