Insurance companies are responsible for compensating chiropractors for services provided to qualified beneficiaries. However, most settlement processes are not smooth. This is due to the common practice of insurance carriers to attack chiropractic bills and records, primarily because of an omission on the chiropractor’s part.
Statistics show that approximately 49% to 80% of medical claims have at least one error. As a result, this affects your practice’s bottom line and leads to revenue loss. This post looks into ten of the most common chiropractic claims billing mistakes and how to avoid them.
1. Typographical Mistakes
Many people consider misspelling names, swapping letters, or entering wrong addresses as minor mistakes in chiropractic claims processing. However, the truth is that these ‘minor’ mistakes can result in denied or delayed claims by an insurance carrier. In turn, such denial can lead to frustration for both you and the patient.
Thus, it is vital to avoid any form of typos filing a chiropractic claim to an insurance company. Ensure that you verify the numbers and spellings of the contact details, social security number, and policy number of the patient, as well as the insurance provider. You can opt to use reliable chiropractic billing software to assist you in preventing these mistakes. However, ascertain that new patient data is thoroughly verified before invoicing to avoid potential errors.
2. Inaccurate Patient Records
One of the most common mistakes that insurance companies notice from chiropractic claims is that they usually copy and paste the same entry into the patients’ records for each day they receive treatment. In other words, when they find that the information under patient history, examination, results, and treatment plans are identical, insurance companies argue based on the inaccuracy of the records.
Most attorneys for the insurance companies will also argue in court that the chiropractor is ‘money-hungry’ or ‘lazy.’ Thus, it is vital to always enter accurate information on the patients’ health during the course of their treatment in your practice. Avoid copy-pasting the sections.
3. Duplicate Billing
Another standard chiropractic claims billing mistake is when the biller repeatedly requests payment for the same service. It is common to find that a chiropractic doctor and nurse have prescribed the same patient the same treatment, leading to double billing for the same procedure.
These billing mistakes tend to frustrate patients and can even harm your practice’s reputation. Many consider it an intentional act to gain additional money and, as a result, act accordingly. Thus, taking the time to ensure you’re not double billing patients for services rendered saves you time and effort trying to mitigate the issue with the patient and insurance carrier. Before any bill is sent from the office, any entry that seems to be a duplicate should be looked into and verified.
4. Coding Errors
It is common for healthcare practitioners and their staff to stay updated on the latest coding regulations. When filing claims, the diagnostic and treatment codes must be compatible. However, you will find that many chiropractic practices either upcode, which is misrepresenting their provided services using a code for a more severe or extensive procedure than what the patient received, or under code, which is vice versa of upcoding.
In addition, there were more than 70,000 codes within the 2021 fiscal year, with at least 500 new ones. As a result, it can be challenging for chiropractic practices to always be aware of these codes. However, several medical billing software systems can ensure that your coding information is up to date while automating compiling and collecting all the patient data required before sending it to the insurance company.
5. Lack of Well-Trained Staff
During staff turnover in chiropractic practices, it is common to find inexperienced employees responsible for handling complicated billing processes. Since insurance companies are not always available to provide clear and accurate information on billing processes, employees usually have the task of figuring out how to deal with complex billing on their own.
Thus, it is vital to implement the proper training programs in chiropractic practices to ensure new and old employees know the billing process. Automated systems simplify the entire billing process and can prevent mistakes and knowledge gaps during employee turnover.
6. Coverage Limits
Another common chiropractic claims billing mistake is when the practitioner files a claim for services the patients’ insurance does not cover. It is the responsibility of chiropractic practices to verify the eligibility and benefits of the insurance coverage of each of their patients.
Determining the percentage of covered visits, outstanding deductibles, and copayments helps provide your patients with an accurate projected cost without compromising pricing transparency.
7. Expired Coverage
This is when a practitioner submits a claim for chiropractic services rendered after the patients’ insurance coverage has expired. You should ask the policyholder to inform your clinic if they have moved employment or obtained a new insurance card to prevent insurance difficulties. Verifying chiropractic insurance eligibility may assist in ensuring that patient information is current.
8. Problems with Coordination of Benefits (COB)
COB is the process of identifying whether an insurance provider will act as the secondary or primary payer to cover the claim benefits for patients with multiple medical insurance plans. Since most clinics do not request information about supplemental insurance, using COB when processing medical claims aids in identifying the primary payer’s obligations and deciding the secondary payer’s portion.
Providers must collect and verify the secondary and primary insurer information at each visit to reduce COB worries. It is also essential to familiarize yourself with payer guidelines and payment plans before sending the claims to the primary payer. Likewise, the secondary payer often requires a copy of the primary payer’s Explanation of Benefits (EOB) before processing and settling a claim.
9. No Authorization or Referral
Several chiropractic services require authorization from the insurer. Failure to seek such approval can lead to the rejection of the claim. Chiropractic practices must determine which insurance companies require pre-authorization for specific services and procedures before conducting the operation. They should also provide predeterminations for sophisticated and expensive treatments from providers whose services require pre-authorization.
10. Failure to Submit the Chiropractic Claim on Time
There are deadlines for filing claims with each insurance provider. They reject claims submitted after the policy’s period has passed. While some insurance policies demand that claims be filed within a year of the appointment date, others may only provide 180 or 90 days. It is good practice to submit the claim as soon as the treatment is complete.
Apex EDI’s Services Can Help You with Your Chiropractic Billing Processes
Apex EDI’s software streamlines the processing of claims for chiropractic, dentistry, optometry, as well as other medical specialties. Our flexible software can handle your chiropractic claims billing process from beginning to end, saving you both time and money.
Our program completes this procedure in an average of two minutes, providing you more time to take care of patients or complete other crucial practice duties. Chiropractors are already using it all over the US to transmit claims at the push of a button.
The Apex One Touch not only sends claims but also notifies you of the progress of filed claims and confirms patient eligibility. The program also streamlines ERA 835 transactions and organizes patient information.
Contact us for a free and live demonstration of how our software functions.
DateNovember 21, 2022