It is very important that chiropractic offices comply with Medicare and private insurer requirements. From coding and coverage to documentation of services, there are several factors that need to consider if providers want to get paid on time.
Improper claim submission needs to be avoided at any cost because if the claims don’t meet Medicare requirements, CMS will continue denying them. This will resulted in a significant loss of time and money that no chiropractic office would want to happen.
Here are three common mistakes that chiropractic offices make when submitting claims. These mistakes result in claims either getting rejected or denied:
- If there are mistakes in paperwork or if billers have filled wrong information in claims, then it will lead to denials. Billers cannot afford to make silly mistakes such as mentioning wrong ID number or any other technical error.
- Second common mistake is – not checking claims for coding errors. If a billing department is using paper billing, relying on templates and not checking the claims before submission, denials are bound to happen. Even though electronic billing has become a standard process, there are still many chiropractic offices relying on older billing methods. This holds them back from getting paid on time.
- If claims don’t have sufficient documentation, payment can get delayed or rejected. There are several rules for coverage by insurance companies and it is important that claims are establishing the necessity of patient care. So practices need to keep documentation complete so that problems with payment can be prevented.
There are several other reasons why chiropractic claims get denied. For instance, if billers are not using modifiers correctly, it will lead to denials. Improper use of E/M codes is also a reason for claim denials.
Today, there are several ways in which chiropractic offices can enhance reimbursement. For instance, they can participate in federal programs that have been designed for encouraging the provision of quality, cost-effective care. Even their participation in MIPS (Merit-based Incentive System) can help them boost revenue.
Accuracy in coding is also a requisite that needs to be fulfilled. Only when coders are performing error-free ICD-10 coding, they can ensure that claims are being reported with increased specificity that is required for measuring the performance of the healthcare provider. It is important that the chiropractic office is hiring a team of experienced coders and billers for this task.