Chiropractic billing and payments guide

Chiropractic billing and payments can be tricky to wrap your head around, but doing so will enable you to process payments quickly and ensure that you receive the correct reimbursement.

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Chiropractic billing and payments guide
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Chiropractic billing guide for increased revenue

Chiropractic billing guide for increased revenue

Billing and payments can be tricky to wrap your head around, however, you must have a good grasp on the necessary business practices concerning all your billing. Doing so will enable you to process payments quickly and accurately, and ensure that you’re receiving the right reimbursement amounts to increase your revenue. To help you, we’ve touched on some important aspects that go into chiropractic billing that can also work towards increasing the marketing of your chiropractic business.  

Experience & track record

Chiropractic billing doesn’t have to be handled all by yourself, and there’s no shame in reaching out to professionally trained specialists who can help with your billing and coding procedures. They are highly familiar with this sort of information, and have the knowledge to be able to track and submit claims, follow up on any outstanding or concerning details, as well as validate payments. Outsourcing can be a great way for you to increase efficiency within your clinic, and it can effectively reduce the likelihood of claims being rejected. Chasing up on rejected claims can result in significant delays when it comes to reimbursement, and it can also be a very time costly process, with staff having to set aside time to revise information. So don’t shy away from hiring professional help, as it can increase efficiency within your chiropractic systems. 

Saving time & money

Being educated on billing and payment processes can also result in sufficient transfers of payments, meaning all your transactions will go through smoothly without needing to spend time following up on payments that have gone awry. Considering that many patients pay before their services, if staff don’t know how to process payments properly, this can result in costly mistakes, as well as frustration for the patient. Finances are a particularly sensitive topic, and it's best dealt with swiftly, so making sure you and your staff are aware of billing practices can save you an abundance of time. Having the expertise to deal with payments can increase productivity, efficiency, customer satisfaction, and overall revenue, so it's of the utmost importance that you prioritize this.

Chiropractic CPT code cheat sheet

One of the most important aspects of payment and billing when it comes to chiropractic clinics is being able to accurately apply CPT codes. While each chiropractic clinic is likely to use some codes over others, we recommend that you create your own cheat sheet over time with the codes that you frequently use for patient billing. 

What are chiropractic CPT codes?

Created and maintained by the American Medical Association, chiropractic CPT codes are five-digit codes that pertain to specific diagnostic tests, medical services and procedures, as well as evaluations. When it comes to billing, they’re a quick shorthand way of outlining the services used, and allow you to be reimbursed for exactly what was used. The code set is quite large, and they can code for a variety of different procedures. They are essential in specifying to insurance companies what procedures were performed, and what is eligible for reimbursement. They must be accurate, as different insurance companies cover different procedures, and you need to ensure you are being paid for the services you provide. 

What CPT codes can a chiropractor bill?

There are thousands of different CPT codes that a chiropractor can bill, and the ones you choose all depend on the services you offer. Don’t worry about learning all the codes, as it is highly unlikely you will use every single one! For now, it is helpful to know the most common ones that you are likely to encounter, so you can become familiar with their application. Specifically, when it comes to chiropractic clinics, most use Category 1 codes, which describe procedures performed by healthcare providers in both outpatient and inpatient offices. Some examples include:

  • CPT Code 99203 – Initial Exam
  • CPT Code 98940 - Chiropractic manipulative treatment (CMT); spinal, 1-2 regions
  • CPT Code 97110 – Therapeutic Exercise 

As a chiropractor, there are also four codes commonly used for chiropractic treatment, with these based on the spinal regions treated. These include the following:

  • CPT Code 98940 Chiropractic manipulative treatment (CMT); Spinal, 1-2 regions
  • CPT Code 98941 Chiropractic manipulative treatment (CMT); Spinal, 3-4 regions
  • CPT Code 98942 Chiropractic manipulative treatment (CMT); Spinal, 5 regions
  • CPT Code 98943 Chiropractic manipulative treatment (CMT); Extraspinal, 1 or more regions

It’s important to remember that you are applying what is relevant, and listing the exact number of regions specified within the code.

Chiropractic CPT code cheat sheet
How do chiropractors bill insurance?

How do chiropractors bill insurance?

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. 

Requirements

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. 

Chiropractic coverage

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.

Challenges in chiropractic billing

Chiropractic billing can certainly feel complicated, and we acknowledge that some challenges can take some time to get used to. There are easy ways to overcome these, and using chiropractic medical billing software, and simply being aware of the common pitfalls will help you to avoid potential turmoil. 

Denied claims - It’s quite common for claims to be denied or rejected when it comes to insurance reimbursements, which can be costly to deal with. Chasing up on rejected claims can waste a lot of time, and so it’s important to always provide sufficient evidence in the document creation process to avoid dragging out payment processes. If you have a high claim denial rate, it’s likely to cause strain on your professional relationships with patients and staff, and can prevent you from being able to invest, develop, and grow your practice. 

Inflexibility - Depending on the software you use, many services are inflexible to changes such as fluctuation in patient numbers, and changes in insurance information. You must incorporate a system that is customizable to your needs and can adapt to improvements in billing processes. Especially in the healthcare environment that is highly subject to changes constantly, it’s important you can execute effective patient management and payment transactions. 

Outdated processes - Collecting payments manually is a very tedious process, and wastes a lot of time and money. This is the same for outdated payment systems, as despite being electronic, they can still struggle to handle payments efficiently. You must use billing software to auto-generate claims to increase productivity, accuracy, and customer satisfaction.

Challenges in chiropractic billing
Benefits of software for chiropractic billing

Benefits of software for chiropractic billing

In fact, using billing software for all your chiropractic payment and billing needs is the best way to go when it comes to dealing with insurance and reimbursements. With medical billing software, such as Carepatron, you can work towards streamlining all your business processes, and increasing the revenue of your chiropractic business. Using Carepatron’s software, you can access all billing and payment information from any time and place, making it a highly convenient option. Patients can choose to pay from a variety of payment methods, and digital invoices can be automatically generated in seconds, which ensures quick and efficient payment transactions. In addition to this, you can also access clinical documentation and notes, video conferencing features, and appointment scheduling services to meet all your chiropractic needs. Carepatron is here to support you on your journey towards success, and with all it has to offer, you can’t possibly go wrong with selecting one of the leading options when it comes to medical billing. Billing doesn’t have to be complicated, and with Carepatron, you can alleviate all anxieties, and work towards doing what you do best; caring for your patients. 

Further reading:

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Improving revenue in your chiropractic practice
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Strategies for marketing your chiropractic solutions
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