Tag Archives: Insurance

Six Myths of Chiropractic Billing

7 Apr

https://www.podbean.com/media/share/pb-raf26-ad3c71

Six Myths of Chiropractic Billing

Welcome to Billing Buddies YouTube and Podcast series. 

In this episode, we will be discussing six myths of chiropractic billing. Billing Buddies has been doing chiropractic billing for 25 years and over the years have experienced doctor offices having misinformation.   We will share six areas that are commonly misunderstood.

Myth # 1:  Chiropractors need X-rays on all Medicare patients

Answer:  On January 1, 2000, Medicare gave the option to doctors to take X-Rays or do a PART exam to demonstrate subluxation of the spine.  Review your Medicare LCD (Local Coverage Determination) to see how to properly document a PART exam.  The LCD’s can be found at your local carrier’s website or there’s a link at www.cms.gov.

Myth # 2:  Chiropractors need an ABN on all Medicare patients

Answer:  ABN’s (Advanced Beneficiary Notice) are only required on covered Medicare services that don’t meet Medicare coverage guidelines.  ABN’s should be given on a case by case basis.  For example:  if you are providing a 98940, 98941 or 98942 service and the patient is on maintenance care, an ABN should be presented to the patient.

Myth # 3:  Chiropractors can’t charge an exam fee for Medicare patients.  

Answer:  Charging practices need to be uniform for all patients.  Practices need to charge Medicare patients for exams even if they are not covered by Medicare.   By failing to charge Medicare patients, practices are profiling patient segments and charging differently which is prohibited by CMS.

Myth # 4:  Chiropractors can opt out of Medicare and charge Medicare patients directly. 

Answer:  Chiropractors cannot opt out of Medicare.  If a chiropractor does not have a PAR or a Non-PAR Medicare contract, he cannot treat a Medicare patient.  The patient needs to be referred to a chiropractor that has a Medicare contract.

Myth # 5:  Chiropractors can’t charge for therapy services.

Answer:  Charging practices need to be uniform for all patients.  If provided, chiropractors need to charge Medicare patients for therapies even if Medicare does not cover them.

Myth # 6:  Chiropractors (or any healthcare professional) can write-off hardship balances for low income patients.

Answer:  Healthcare providers may write-off balances for hardship if they have a hardship policy and verify income.  Healthcare providers must have a hardship policy, verify income and follow uniform hardship guidelines for all patients.

These are the six chiropractic billing myths.  This presentation was brought to you by Billing Buddies.  Billing Buddies is a medical billing and consulting service established in 1994.  We offer services to a variety of specialties across the United States.  For more information, please call or text 612.432.2366.  Thank you for listening to Billing Buddies YouTube and Podcast Series and remember to “Buddy Up with the Best”, Billing Buddies.   Have a great day!

 

 

 

 

Six Myths of Chiropractic Billing

6 Apr

Six Myths of Chiropractic Billing

Welcome to Billing Buddies YouTube and Podcast series.

In this episode, we will be discussing six myths of chiropractic billing. Billing Buddies has been doing chiropractic billing for 25 years and over the years have experienced doctor offices having misinformation.   We will share six areas that are commonly misunderstood.

Myth # 1:  Chiropractors need X-rays on all Medicare patients.

Answer:  On January 1, 2000, Medicare gave the option to doctors to take X-Rays or do a PART exam to demonstrate subluxation of the spine.  Review your Medicare LCD (Local Coverage Determination) to see how to properly document a PART exam.  The LCD’s can be found at your local carrier’s website or there’s a link at www.cms.gov.

Myth # 2:  Chiropractors need an ABN on all Medicare patients.

Answer:  ABN’s (Advanced Beneficiary Notice) are only required on covered Medicare services that don’t meet Medicare coverage guidelines.  ABN’s should be given on a case by case basis.  For example:  if you are providing a 98940, 98941 or 98942 service and the patient is on maintenance care, an ABN should be presented to the patient.

Myth # 3:  Chiropractors can’t charge an exam fee for Medicare patients.

Answer:  Charging practices need to be uniform for all patients.  Practices need to charge Medicare patients for exams even if they are not covered by Medicare.   By failing to charge Medicare patients, practices are profiling patient segments and charging differently which is prohibited by CMS.

Myth # 4:  Chiropractors can opt out of Medicare and charge Medicare patients directly.

Answer:  Chiropractors cannot opt out of Medicare.  If a chiropractor does not have a PAR or a Non-PAR Medicare contract, he cannot treat a Medicare patient.  The patient needs to be referred to a chiropractor that has a Medicare contract.

Myth # 5:  Chiropractors can’t charge for therapy services.

Answer:  Charging practices need to be uniform for all patients.  If provided, chiropractors need to charge Medicare patients for therapies even if Medicare does not cover them.

Myth # 6:  Chiropractors (or any healthcare professional) can write-off hardship balances for low income patients.

Answer:  Healthcare providers may write-off balances for hardship if they have a hardship policy and verify income.  Healthcare providers must have a hardship policy, verify income and follow uniform hardship guidelines for all patients.

These are the six chiropractic billing myths.  This presentation was brought to you by Billing Buddies.  Billing Buddies is a medical billing and consulting service established in 1994.  We offer services to a variety of specialties across the United States.  For more information, please call or text 612.432.2366.  Thank you for listening to Billing Buddies YouTube and Podcast Series and remember to “Buddy Up with the Best”, Billing Buddies.   Have a great day!

Changing of the Codes; ICD-10 and CPT Codes

4 Feb

https://www.podbean.com/media/share/pb-einvm-a6b4a6

Changing of the Codes; ICD-10 and CPT Codes

 

Welcome to Billing Buddies YouTube and Podcast series. 

In this episode, we will be discussing the annual changing of the codes; particularly, the ICD-10 and CPT codes.

Healthcare professionals, medical billers and payers rely on several types of codes sets in order to communicate pertinent information about patients.  These code sets include TOS (Type of Service); POS (Place of Service), and NPI (National Provider Identifier) to name a few.  In this writing, I will address the codes that are updated annually, the ICD-10 and CPT Codes.

The ICD-10 codes are specifically called either ICD-10 CM or ICD-10 PCS.  The ICD-10 CM codes are used for all healthcare settings except hospital inpatient settings where ICD-10 PCS codes are used.  For the purposes of this writing, I will be referring to ICD-10 CM codes and abbreviate them to ICD-10.  Each year on October 1st, the ICD-10 codes have revisions, additions and deletions.  These codes are copyrighted and maintained by the World Health Organization.  The ICD-10 codes define the diagnosis of the patient.   There are many free resources online for healthcare professionals and billers to find the updated codes.  One of my favorite sites is the www.icd10data.com.   On this site, you can see the added, deleted and revised codes.   Codes with red arrows next to them signify codes that are non-billable/non-specific codes.  These codes cannot be used for billing purposes.  Codes with green arrows next to them signify codes that are billable codes.  It is important to note that diagnosis codes should be coded to the highest specificity.  Besides free online resources, ICD-10 coding books may also be purchased from several publishers.

CPT codes are copyrighted and maintained by the AMA.  CPT is the acronym for Current Procedural Terminology.  The CPT codes define the services and procedures received by patients.  Each year on January 1st, the CPT codes have revisions, additions and deletions.   The CPT coding updates need to be purchased either in books or an online subscription.   Many of the CPT codes are addressed in payer policies and can be read for free online, but for a complete resource, it is best to purchase an updated manual or online subscription.

It’s important to note that HIPAA defined which codes sets are used to communicate.  Prior to HIPAA, many payers defined their own codes sets.  For example, in some specialties, like chiropractic, codes varied by payer.  Medicare, worker’s compensation and commercial insurance each had their own code sets.  HIPAA streamlined the coding processes by defining one code set for each data element.

In summary, whether you use online resources or purchase manuals, it is important to note that ICD-10 codes update each year on October 1st and CPT codes update each year on January 1st.  You want to stay updated to the most current codes to be compliant with your coding and billing and to reduce denials from payers.

This was brought to you by Billing Buddies.  Billing Buddies is a medical billing and consulting service established in 1994.  We offer services to a variety of specialties across the United States.  For more information, please call or text 612.432.2366.  Thank you for listening to Billing Buddies YouTube and Podcast Series and remember to “Buddy Up with the Best”, Billing Buddies.   Have a great day!