Insurance is a vital component of billing and payment processes, and it’s important that as a chiropractor, you consider the standard insurance billing processes. Following this guide to insurance for chiropractors, you’re well on your way to fast reimbursements.
Firstly, you must perform all your services as a licensed provider, which means chiropractic assistants and such are not eligible for reimbursement. As a licensed provider, you should be following standards and regulations as outlined by the American Medical Association (AMA), the Current Procedural Terminology (CPT), the Healthcare Common Procedure Coding System (HCPCS) and the Centers for Medicare and Medicaid Services (CMS). Because these rules are often subject to changes, you must take note of any edits and use appropriate modifiers where necessary. Following these rules should reduce the chance of claims being rejected, as well as demonstrate clear medical necessity for all services and treatment that you provide. Different insurance companies have their own assessment criteria for this, however, using evidence-based standards should be sufficient.
For chiropractic coverage (meaning any reimbursement pertaining to evaluating services, procedures, radiology, and other modalities), you must provide relevant documents. All diagnostic imaging services must have corresponding evidence to highlight their necessity, to meet the reimbursement policies of insurance companies.
Documentation of patient records
One of the most important aspects of insurance bills is accurate documentation of patient history and treatment. Each patient must have their own health record that is dated and signed by you, and is accessible to external audits. For initial visits, patient record documentation must contain details concerning the patient’s history of their medical conditions and illnesses, as well as notes on any allergies and reactions. You must describe the current state of the patient’s illness, including their symptoms, experience, interventions, treatments, medication and any other notable qualities. You must also evaluate the physical condition of their health, as expected in a chiropractic clinic, by assessing details through PART criteria. This includes any pain, misalignment, the range of their mobility and motion, as well as any abnormalities in their tissue tone, texture, or temperature. Diagnosis and treatment plans must also be noted, such as in a SOAP note format to guarantee effective evaluative care for reimbursement.