Chiropractic Medical Billing in 2017 – Things Practitioners Should Know

This is Rajeev Rajagopal. I will come to Outsource Strategies podcast. Today we will just discuss a little bit on chiropractic medical billing in 2017. Things most practitioners should know and will help them through their reimbursements, while they bill for their chiropractic care. Chiropractic, as you know diagnose and treat a wide variety of health conditions, including pediatric ailments, and can order imaging studies if required. And depending on whether its Medicare or whether its other specialty insurances, your ability on reimbursements do change and its important for you understand that. Proper documentation is very critical. It’s very very important to make sure that proper documentation is done for every visit that your patients come to you for. 

It is a great option for musculoskeletal injuries, especially things such as back pain. Besides spinal manipulation, treatment plans may include soft tissue work, rehabilitative exercises, physical therapy, and there are chiropractors who even provide nutritional lifestyle counseling. There’s actually a study published in the Journal of Occupational Rehabilitation, which further strengthens this view. It says that workers who see a chiropractor first for a workplace injury gets back to the job faster. The findings of the September 2016 study from the University of Montreal are based on data from more than 5,500 injured workers in Ontario. Having said that the place for chiropractic care is very strong, now how do we get reimbursed for all that?

When it comes to payment, practitioners need to understand the nuances of chiropractic medical billing and coding which are quite different from other specialties. Medicare has special reimbursement rules, and Medicare Access and CHIP Reauthorization Act 2015 or MACRA, which came into effect on April 16, 2015, includes provisions related to chiropractic services. We have to be very conscious of this, when we do medical billing. According to the Centers for Medicare and Medicaid (CMS) chiropractic services, have the highest rate of improper payments for Medicare Part B services. Medical billing education is crucial to overcome this challenge. Here are some key important parts that if you follow that your reimbursements will be much better.

As specificity in documentation, you have to be very specific to the area that you are dealing. If it is Medicare and it is subluxation, chiropractic care for subluxation has to be specific to either cervical or thoracic lumbar or two different areas. But if you are going to provide adjustments or manipulation to those areas, you have to document that correctly. That documentation is what is going to reimburse you for the services that you provide.

Pre-payment authorization review: Starting 2017, chiropractors who fail to meet documentation and billing specifications will face pre-payment authorization review. Payers, including Medicare, scrutinize practitioners whose billing patterns do not meet predetermined norms and have documentation errors rates of 85% or higher. Erring providers will be placed on a prepayment audit review in order to justify payment based upon a review of medical records. Opting for medical chart audit services is a good strategy to avoid prepayment audit review. Medical chart review will ensure that all the information in the patient’s medical chart is complete and accurate, supports the code submitted. So, definitely review your charts before you actually send them out. Review your notes. Review your documentation. Extremely critical to make sure that there are no errors in the process of billing or coding.

ICD-10 chiropractic code deletions and additions for 2017 are also important to know.  Starting October 1, 2016, five ICD-10 chiropractic codes were deleted and several new ones added. For instance, the new ICD-10 codes in M.50 category for 2017 include M50.0 Cervical disc disorder with myelopathy, then there is M50.1 which is Cervical disc disorder with radiculopathy, M50.2 which is Other cervical disc displacement, M50.3 is Other cervical disc degeneration, M50.8 Other cervical disc disorders, M50.9 Cervical disc disorder, which is unspecified.

You see the pattern. What they are looking for is for you to provide them specificity in terms of the diagnosis and the services provided. If you have a diagnosis saying cervical disc disorder with radiculopathy, you have to show in your notes how you reached that conclusion, what were the tests that you performed, what were the symptoms, if the patient had pain radiating from the neck to the shoulder etc.

For each of these ICD-10 codes, there are codes that indicates diagnosis in greater detail for the high cervical region. The same goes for mid-cervical region, and at C4-C5 level, and C5-C6 level, and C6-C7 level. The 2017 ICD-10-CM codes are effective for patient encounters starting from October 1, 2016 through September 30, 2017, something to note.

Chiropractors need to update themselves on the new codes and alter the billing practices accordingly. If this is what you bill Medicare, you need to be sure that you are doing the exact same thing for other insurances as well. Of course, for other insurances, you do not just bill for subluxation. There are some insurances that might pay for other issues as well, back pain or shoulder pain. Some of them might cover for certain other ailments as well. So, be aware of the changes that are there for other insurance plans that you can get reimburse properly for the services that you provide. Other than subluxations or manipulations to the cervical spine, these other insurances such as Blue Cross, Aetna might reimburse you for certain other modalities and you need to know what they are. If it is exercise, how do they reimburse for it. So, billing is not just about one area, one insurance. It is you have the ability to know exactly how to bill for individual insurances. If you take your office and take a look at all the insurance plans that are available in your office, you need to break them down into is it Medicare that I have more, or do I have Blue Cross more, or Aetna more, your billing team needs to know exactly what the plans or requirements are. Other than Medicare, some of the other major medical insurances require prior authorizations, prior verifications. Before you can treat, you need to know the rules. All of these are important when you run a chiropractic practice.

I will go ahead and talk about, you know chiropractic reimbursement for other insurances as well in future. Hopefully this helped you. I know I covered more on the Medicare side and I’m hoping that you will go and dig deep into the ICD-10 reimbursement guidelines or ICD-10 coding guidelines for chiropractic care. So, you are properly documenting, reviewing and coding and billing correctly so that your AR team does not have to do or spend a lot of time trying to capture the money that is left out there.

Would help to your practice until next time.

Thank You!