Chiropractic claims are a little different than most other medical claims. Chiropractic services have only recently been considered medically necessary, and only under very specific circumstances. This makes it even more important for claims to be done correctly so as not to be rejected by insurance companies.
Who Covers the Procedures?
Most insurance companies will only cover procedures where a patient’s spinal column is manually manipulated to correct an issue of alignment, physiological function or movement integrity. This does not include any other services the chiropractor may offer such as diagnosis of the issue, although a diagnosis is necessary to show the insurance company that the service was medically necessary. As well, the patient must exhibit a significant health problem that justifies the use of manual manipulation of the spine.
This means that subjective comments from the patient, objective findings, diagnosis, and treatment must all support the medical necessity of the procedure in order to receive payment from the insurer. It’s important to make sure that you are using the proper billing codes so that it is clear what is being charged for and that the services meet all of the necessary requirements. Codes should be specific to the region that was treated, even if the entire spine was manipulated as part of the treatment. As well, patient information must be accurate and updated frequently to avoid claim denials and rejections.
Chiropractic medical claims require more explicit accounting practices than other more traditional medical claims, and mistakes can lead to headaches when having to deal with insurance companies that are hesitant to cover services. Consider hiring a medical clearinghouse that knows the ins and outs of chiropractic billing, and can ensure that you’re sending the most accurate billing information the first time. Apex EDI offers services to medical, dental, vision, and chiropractic practices and thoroughly vets claims before they are sent on to insurers. Request a demo today to see how Apex EDI can help your chiropractic practice get their claims in order.