Medical Billers for chiropractic

Top 5 Reasons for Hiring a Medical Billing Specialist for Chiropractic

Medicine is a field that is constantly evolving and revolutionizing – out of the many specializations that exists, there can be no doubt that chiropractics is gaining more and more interest and recognition. However, being a chiropractor and running your own medical service means that you not only have to worry about your patients’ welfare, but also running a whole hospital, from billing to insurance follow-ups, which is not easy!

Here are the top five reasons why you should consider outsourcing that work to a medical billing specialist –

  • Codes – A specialist is well-versed with the newly launched ICD-10 codes that are essential to proper filing and following-up of the insurance claims. In the previous system, the average chiropractic needed only about 75 codes a day or so; today, the number has tripled, since the codes are highly detail-oriented. From recording the data to presenting it properly, having a specialist to do it for you will definitely make things easy.
  • Experience – It goes without saying that a specialist is experienced and has contacts that you probably don’t. They can expedite your claims, handle denied claims with finesse, maximize your profits and review your data to make sure you’re on the right track, so that your resources are better utilised.
  • Administration – A specialist not only knows codes, but also handles the administrative side of things. They are experts at data-collection, recoding and processing, which leads to exact insurance follow-ups, a good payer and patient relationship, prompt collections and well-maintained, transparent electronic records so that you can focus on patient care instead.
  • Reduce Costs and Increase Profits – If you hire your own staff, chances are that you’re going to have only one or two people to handle everything by themselves, and they may or may not well-trained. A specialist, on the other hand, is experienced, which means they cost far-less and can save you a lot of time and effort when it comes to training, technology upgrades, etc.
  • Other Services – Specialists also often offer additional services like free-analysis of the data collected and presented, client reporting, patient feedback, etc.

Ultimately, a specialist frees up more of your time and energy so that you can devote it to your patient and his/her health!

Cardiologist dealing with medical biller

Top 5 Things for Cardiologist Should Know before Dealing with Medical Billers

As a cardiologist, you have to make split-second decisions and perform high-risk procedures that will often leave you stressed out and worried. Without doubt, delivering best patient care possible is your top priority – handling the administrative side of things can become an added burden you really don’t need! Hiring out to medical billing services is an excellent idea, but here are a few things you must be aware of before you do that –

  • Knowledge of Codes – Cardio-procedures are some of the most complex in the entire medical field. You’ll have to look through a bunch of coders to find someone who has a good working knowledge of the codes, especially with the new ICD-10 coding.
  • Knowledge of Cardio-Procedures – The medical billing service must also be well-versed in cardio-procedures so they’re exact in their data collection/processing. For instance, contractual adjustments in cardiology are far more complex than that of a general physician’s. Generalist billing means you’ll have insufficient documentation and as a surgeon busy making split-second decision, you can hardly spare the time to take detailed notes about dates, procedures, etc. Pick someone who knows the ins and outs of the coding process, but also has a working knowledge of the procedures to make things easy.
  • Industry Experience – It goes without saying that a medical biller who’s had experience working for a cardiologist prior to you is better suited to your needs. Not only do they have a good idea about what you’ll require of them, they’ll also have contacts and connections in the field that will expedite the insurance processes and data dissemination.
  • Software Usage and Transparency – Not only will your biller need to have proper software to collect data and process data, they will also have to have contingency plans for data recovery and backup. In a complex field like cardiology, patient confidentiality, history and access are extremely important to a physician. You’ll want to make sure that they have a proper system that creates the right electronic trail that you have complete access to.
  • Handling People – Maintaining patient balance is tougher for cardiologists, who have insurance companies taking longer times to deliberate each case. A medical biller who doesn’t have the people skills required to soothe both irate patients as well as demanding insurance companies will cause more harm than good, so look out for those with charm as well as knowledge to back it up.

As a cardiologist, you want someone who can back you up when you’re busy trying to save someone’s life, so pick a partner who has your six at all times!


10 Reasons for High Denial Rate for Medical Claim

Denied and rejected claims are the main reasons for low revenue cycles for medical practices. Sustaining an optimum & POSITIVE claims outlook needs an eye for detail as regards every minute aspects of patient care plus the medial billing infrastructure also matters a lot.

  1. Incorrect patient identifier information

Patient Names with wrong spelling, inaccurate Date of birth having related entries that doesn’t match or may be the endorser’s number is missing or there is an invalid Insurance provider number which is missing or invalid all such gaps adds up to the problem of claims getting rejected.

  1. Discontinued Coverage – treatment does not qualify for Health Insurance

Knowing what insurance benefits goes with what kind of health condition needs to be understood in the beginning itself before availing the insurance services. Moreover at times the insurance provider may not consider your claim as they may think that the medical treatment that was taken was optional and so need not be covered, or perhaps the Medical care given was unnecessary. In such circumstances the doctor who was treating the patient need to come forward and justify the treatment procedures that were adopted and provide enough medical & circumstantial evidence to justify the medical care or treatment rendered to the patient.

  1. Prior authorization or pre-approvals NOT in place

Many treatment methods like CT scans or MRIs generally entails preauthorization or pre-notification, which is in addition to the testimonials and is one level higher than plain referrals. Therefore if the treatment was done without the insurance company’s preapproval in their system or if there is no preauthorization number then the claim stands to get rejected.

  1. Medical Services not covered under Insurance

One of the reasons the claim gets rejected is because the treatment was based on diagnostic procedures which comes under the non-covered category.
Thus this makes it another reason why it is imperative to touch base with the patient’s insurance provider before availing the insurance services.

  1. Medical Records not requested or denied

Request for accessing medical records may be denied by Health care agencies having some degree of limitations as per HIPPA & other federal laws, also the patient gets written notification if the requests pertaining to his or her medical records indeed have been denied.

Thus such records which may go unnoticed may have errors as discussed earlier also such erroneous records gets carried forward and becomes a part of the shared information with other medical records thus causing discrepancies in the case history & other treatment related documents.
So when such erroneous information gets processed by insurance companies it certainly will cause issues and problems leading to claim getting rejected or denied.

  1. Benefits Not coordinated among Insurance providers

Along with wrong patient details, providing wrong hospital or medical provider details is a common cause for claims getting rejected since coordination between medical providers & medical insurance companies gets messed up. Also (EOB) statements linked with the claim having omitted information caused the claim to be rejected.

  1. Billing company(s) not at par with the latest health care systems & policies

In many cases some billing companies may use legacy systems which may not be fully complaint as per the new treatment and diagnostic regulations & policies eg : ICD 10 OR HIPPA norms, & so it may not concur with the latest regulatory norms of the health care industry which can cause claim rejections or denials.

  1. CPT or HCPCS Codes are invalid & missing

When an incorrect diagnosis or point-of-service code is entered into the medical billing system, a claim can end up with errors. Again if treatment and diagnostic codes don’t tally accurately can cause claim rejections or denials.

  1. Timely filing

Keeping the lines of communication between the practice and insurers enables timely filing of claims and so keeps deadlines at bay and reduces the rejection rate for claims.

  1. No referral on file
    During consultation procedures with a specialist, it is required for the patient to get a referral from the family doctor or physician. Sometimes such referrals though provided may not have been fed into the system correctly or they can be back-dated which may cause issues or problems for the claim to be approved.

Is ICD-10 Eating into your Productive Time?

The International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) went into play just this month, after a couple of delays earlier this year. The revised system has more than 68,000 diagnostic codes, as compared to the previous ICD-9-CM, which the physicians and other medical care providers were using earlier on.
It’s very specific and very detailed; for instance, there are codes to distinguish between a right or a left leg even! In theory, such specific coding may sound very beneficial, but in practice, the physicians and medical services have found it extremely tiring to use. The general response is that it eats into much of the productive time that they have; instead of working on patient welfare and care, they are worried about the billing and insurance processing!

  • The clinical team must undergo training to make sure that the descriptors for each diagnosis falls in line with the new billing codes; if the hospital is not outsourcing their billing practices to an ICD-10 coder, then they themselves must learn how to use these codes apart from providing the patient care they already do.
  • Physicians who do referrals are finding it tough; ICD-10 seems to accept only online referrals and no paper. One doctor claimed that the website was not opening properly and she had to wait 3 whole days before the referral was processed; obviously, this is a huge waste of time! Patients require urgent referrals at certain times.
  • Some physicians found it difficult to access the eligibility codes of a patient on the website, which again, was very slow and caused a lot of delay. Now, the doctors who treat patients without verifying insurance cannot get paid; it goes without saying that it thrusts them into a moral dilemma – to treat sick or to wait until they can get paid?
  • Insurance companies are also having trouble finding their footing; they put the medical staff on long periods of holding over the phone and cut into the time that clinical staff should be using to treat patients.
  • Even industry workers don’t seem to be ready to deal with the new coding procedures; many of the reps are still unsure about the entire thing and they just submit the claim and wait around to see what happens. Obviously, time and money are both wasted, especially if the claim does not fall through.

Ultimately, ICD-10 has left much of the medical industry in the lurch. Hospitals that have not hired experts to help them out are finding it tough to manage both patient care as well as these billing issues. Still, the codes themselves are to ensure better care for the public – a little more work on their processing could make them a success!

Medical Billing Practitioner

How to Find the Best Medical Billing Practitioner for your Hospital

Given that your cash flow and your overall profit is heavily dependent on your billing and revenue cycles, it is imperative that you pick the right company to outsource your medical billing services to. The companies that offer medical billing services must perform these functions – generate and submit insurance claims, insurance carrier follow-up, posting and processing the payment, providing both invoice and support to the patients, pursue denied insurance claims, credentialing, medical coding, insurance eligibility verification, etc, etc. It goes without saying, therefore, choosing a good company is one of the most important decisions you will make. Here are a few things you will need to consider before you make that decision –

  • Level of service the company offers you; obviously, you must ensure that the company you’re choosing falls in line with your needs. You may or may not require all the services mentioned above; for instance, if you decide that you want the company to be the one pursuing denied insurance claims, you’ll have to pick a company that offers that service and is transparent above the procedures that allow them to do so. What the company offers you in terms of services and work is something you will need to sit down and plan out according to your business requirements.
  • Experience in the industry; it goes without saying that an experienced service provider is the best. But they’re also a bit expensive and some of them provide specialized services only in certain areas . Billing procedures differ according to the medical speciality your clinic provides; this means that you will have to go in for a company that is experienced in your area of specialization instead of choosing a generic billing procedure.
  • The company’s employees’ certification is also to be taken into account; you want to make sure that they’re certified by the American Billing Association (AMBA), which implies knowledge in areas like ICD-10, CPT-4, HCPCS Coding, HIPAA and Office of Inspector General (OIG) Compliance, information and web technology, insurance denials, appeals, claims and the like.
  • The tech-savyness of the company; the more up-to-date they are with the latest trends in the field, the better! But you must also make sure that they have proper procedures in place for data security (particularly for patient confidentiality), data recovery, data backup and the like. For instance, some questions you can ask them will be – how are claims shared? Will the clinic need to install and maintain software online? Is the technology in compliance with HIPAA? How is the patient’s confidentiality protected?
  • Medical billing service companies offer diffrent types of pricing options – percentage based, fee based or full-time employee (FTE) based. Look up the pros and cons of all of the pricing options and choose the one that best suits your practice before you negotiate your contract.

Once you have taken all these details into account, you can start looking around for a company that fits your criteria. However, it is a good idea to approach official legal counsel, particularly when you’re drawing up the contract – a generic template may leave you hanging in the lurch, especially if you have little to no experience in the field!


EHRs: Why we should like it albeit a bit carefully !

Over the years there has been much discussion across agencies & departments about the implementation & ‘effective-use’ of EHR as it benefits both private practice as well as large hospitals.

As with any mission critical system that is meant to carry out ‘error- free’ sensitive operations with minimum human intervention so also is the intended purpose of EHR.
Apart from the many reasons stated by stakeholders to implement EHR, EHR as a system is primarily meant to minimize medical errors pertaining to both inpatient and outpatient settings.

It all starts with medical documentation which determines how the diagnosis will take shape as a lot depends on the facts & figures pertaining to a patient’s health and if misreported it can have an adverse impact on the diagnosis part.

Moreover EHR does away with the load of processing patient data which certainly is a taxing task for the medical staff as a lot of time is spent on documentation since processing patient records involves adhering to a maze of compliance related issues and so it keeps the medics occupied in admin tasks instead of letting them concentrate more on patient care.

So processing medical records has been the bane of ‘medical fraternity’ as it deals with a deluge of information in terms of patient care which is where EHR comes to the rescue.

Thus the speed & accuracy achieved in processing patient records by using an EHR system certainly leads to better diagnosis. Moreover plain data is some sort of a “liability” but when processed properly it gets converted into information and becomes an ‘asset’ which is exactly what EHR does.

On the one hand EHR has many payoffs specially for ‘physician assistants’ who are part of Specialist -led teams and for them using EHRs as made their task less complex for eg : reviewing medical chart(s) or interpreting diagnostic variables can now be done easily using EHR templates.

However what has been observed & studied is that the true benefits of implementing an EHR system requires some active monitoring & procedural due diligence to be performed, for eg: the simplicity of using EHRs that enables quick charting using diagnostic codes has a lot of room for errors plus such errors can spread as they get passed on to subsequent levels of processing medical records.

Also in cases of processing inpatient and outpatient records using the cloning feature of EHR which facilitates copying of previous entries to the current list of entries can go wrong if done without much care. Thus being careless while using EHR not only jeopardises patient care parameters but the revenue margins of the practitioner may also take a severe beating.

So to conclude in balance, it can be said that errors that otherwise may not have happened using paper based records can and will happen with an EHR based system, so all that we need to do is be vigilant and actively monitor EHR developments at every stage.


COUNTDOWN for ICD-10 has begun! Is the Medical fraternity ready for it

For a lot many in the health CARE industry this whole ICD-10 transition is a Déjà vu, ask them why and one would say “Don’t you remember the Y2K period the world went through“ well I would agree with that.

So today I suppose the whole health care Industry is lucky to have a ready reference base to learn from the Y2K experience making it easier for Stake holder entities such as hospitals and health systems, including insurance companies, vendors & Govt agencies to get ready to meet the Oct -1 deadline as regards moving onto ICD-10. Therefore the general industry outlook is that there is a lot more pending that needs to be done & so a lot of ground remains to be covered for ICD-10.

The above is true, because in a rush to switch over to ICD-10 many Health care Depts did not fully understand the actual need to mover over to ICD-10. According to an industry think tank many have this wrong notion about knowing the complete plethora of codes that forms the ICD-10 model totalling approximately 68,000 codes.. However experts believe that except in the case of large hospitals, majority of the codes will not be used and only a fixed percentage of those codes will be used by practitioners according to what the practise requires

For example a dental specialist may never need to use all the codes, not even 50% will be required as stipulated for dental practise so also for each treatment area only a set of codes relevant for a particular practise will be ever required.

Although health care clinics & General physicians will carry on doing the correct form of diagnosis as part of the treatment methods, however they will continue to use CPT codes for the same. So depending on the practise area it may not go beyond a few hundred codes but certainly it’s not going go the full mile of using all the 68,000 codes.

So as per the above industry mood it seems a reasonable majority in the health care industry is almost ready for the Oct-1 deadline. Nevertheless stakeholders should ensure systems are updated & evaluated against existing limitations & simultaneously plan for training the staff because ICD-10 is just not about diagnosis codes it much more than that.

Moreover Health care depts must ensure EHR and practice management systems are aligned to the transitioning peculiarities from ICD-10 to ICD-9 and a trial run needs to be planned to perform third-party compatibility testing with the clearinghouses and payers to ensure smooth transactions between the sending and receiving parties under ICD-10 mode.

Increase Revenue Margins

How Can Physicians Increase Their Revenue Margin ?

Money saved is money earned! Physicians can increase their revenue margins by using medical billing services offered by experienced medical biller and coder agencies. Medical billing is a challenging task for medical practitioners as its now a full-fledged activity by itself. The physician has to maintain every patient record, fill in the insurance claims which have to be correctly coded. The transit from ICD-9 to ICD-10 will see a lot of changes as the coding pattern have changed and the number of codes for the diagnosis has gone up as well.

It is almost impossible for the physician to concentrate on patients when this administrative work requires as much attention. The employees in the billing department have to be well-versed with all the changes in the health laws and maintain records accordingly. Every time there is a change, the staff has to be trained for the same. This is a huge expense in addition to retaining the staff. Outsourcing the billing department reduces the stress on the medical practitioner where they can focus on the patients while the billing agency handles all the invoices, bills, patient records, insurance claims as well as follow up for small fees. This saves the physician a lot of money as he/she can easily do away with the billing department, which lowers employee cost and its management hassles.

Advantages of outsourcing the medical billing

  • Focus on patients results in patient satisfaction

The physician can concentrate on providing better quality care to the patient as they are free from the hassles of managing the financial aspect of the hospital business

  • Lower billing errors

With the dynamic laws of the USA, experienced coders ensure the accurate claim submission and follow up with the insurance company too. This reduces the number of rejected claims due to billing errors

  • Save money

As the medical billing is outsourced, you are not responsible to pay the billing department employees nor bother about the vacation, pays, benefits or absenteeism. With the law and codes changing, you need not train the employees nor think of ways to retain them. The upgrading of the billing software, the furniture, equipments, etc is not to be maintained.

  • Cash flow improvement

Interruptions in billing delay the payment receivable when your billing staff may go on leave. This affects the timely submission of bills which delays the reimbursements affecting the smooth cash flow. The billing service provider ensures the bills are submitted on time and the cash flow remains steady which is the bottom line of success for your business.

Overall it is advantageous to outsource the medical billing though you as a physician may be worried about losing control or your privacy which is ethically maintained by reputed billing service agencies.

Reasons for Denial Rate

Reasons for High Denial Rate in Chiropractic Medical Billing

Chiropractors like other Physician may overlook certain facts that may lead to mistakes, so as per some Industry studies below given are the reasons as to why claims or payments get denied.

Let’s discuss each reason in detail.

Incorrect Codes

Each treatment type involving diagnostic procedures must be tagged to the correct code having the maximum ‘code digits’ in its category.
For example: the diagnosis for Heart ailments ie : Myocardial infarction starts with 410, but it needs a 4th digit (e.g., 410.0 is Acute myocardial infarction of anterolateral wall).
Therefore Code(s) for treatment should be accurate to the last decimal so as to ensure proper data capture and avoid further confusions in future.

Claim has missing information

All the information as regards patient & treatment/ailments details should be properly filled , any field which does not need to be filled should be filled saying ‘Not Applicable’

So no details or information should be missing else it leads to denial of the claim but the most common missing items are: date of accident, date of medical emergency and date of onset. Be sure to scrutinize all claims for missed fields and required supporting documentation.

Claim not filed on time

Claim processing is all about timing since many claims have to be processed during a stipulated time period which needs to be submitted to various entities like Hospitals insurance companies, Govt offices etc. The reason for claim submission being time sensitive is because majority of treatments cannot wait beyond a certain time and some needs to be treated urgently so all documentation should begin at the earliest so all claims needs to be queued up for claims processing.

Incorrect patient identifier information

Here is the most common of all mistakes committed by patient while filling up the form, name(s) of the patient, the address etc all has to have proper spelling and it should be correct and as per the latest record moreover if it’s a Group claim then patient’s relationship to the insured should be properly provided and the diagnosis code should reflect the exact test /lab procedures so performed. Finally, make sure the primary insurance is listed in the case of multiple insurances.

The use of obsolete coding Manuals such as CPT (Current Procedural Terminology), ICD-9 (International Classification of Diseases) or (Healthcare Common Procedure Coding System) HCPCS will impact revenue generation.

Insufficient documentation

Wrong documentation is the major cause of claims denial. Incorrect Documentation is insufficient to ensure payment for the services which are payable. Fair patient practice mandates that whatever is codded while submitting claims should also be documented and so becomes billable. Therefore proper documentation as regards treatment & diagnostic codes, should be provided to check denials.

Duplicate billing

Often a duplicate bill is the result of manual error. All claim processing methods contains measures to assess claims presented for potential duplication. Such claims are placed into two groups: exact duplicate or suspect duplicate. Due to the type of service, some claims can be considered as duplicates. Proper coding of the service with the applicable codes or modifiers will identify the claim as a separate payable service, not a duplicate for eg : Unbundling & Up-coding are instances of duplicate billing which should be avoided.

Coverage issues (already existing condition, no coverage, lapse of coverage, no chiro benefits)

Medicare is forthright as far as chiropractic services are concerned

According to section 1862(a)(1)(A) of the Social Security Act, Medicare will not cover services that “are not reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member.”

Therefore chiropractic services covered under insurance is only for spinal manipulation and subluxation must be the primary diagnosis. However, in addition to subluxation, it may involve a secondary neuro-musculoskeletal condition.

Some medical plans have reservation like Services not covered/partial coverage or capping on some services. Also insurance information can change at any time, therefore it is important to verify eligibility every time services are provided.

Patient Privacy Protection

Patient Privacy Protection: HIPPA versus State laws

Health care industry is one that accords accountability as one of its most important service deliverables as regards Professional integrity & medical ethics.

Going by the above principle of medical standards each healthcare employee ensures that nothing compromises the privacy of a patient. Over the years the medical community has dealt with issues to maintain patient confidentiality and had faced several challenges in the past, until it came up with the Health Insurance Portability and Accountability Act (HIPAA).

During the start of ones’ medical career itself, health care professionals are made aware about the significance of (HIPAA) it just does not apply to health care professionals infact anybody working in the health care industry or related to it, is required to be trained on HIPAA.

Moreover from an administrative point of view HIPAA offers many benefits to coders & billers involved in processing patient records as it details with a lot of data which only a few are privy to. So, the Role of HIPAA in Healthcare Billing is paramount

So why go for HIPAA, when there are already federal & state laws for the medical care industry?

The following examples will make the above thought clear.

Patient Consent

Physicians must make sure that the patient signs a consent form for sharing the patient details only for medical purpose. In some states the local state law applies instead of HIPAA as it offers more privacy protection than what HIPPA would offer also some states may have similar laws where HIPAA would take precedence over state laws.

Patient access to Psychological treatment records

HIPAA guidelines allows patients to go through their medical records except for records pertaining to Psychological treatment records etc. But again some state laws permit the patients to even access such psychotherapy records and in this case too state laws provide the patients greater access to patient records so that patients can know what is the course of the treatment that the patient is being subjected too.

Summons as regards patient records

Again sometimes patient records can be made available from psychologist without necessarily taking consent from the patient under HIPPA law. However, under some state laws psychologists are prohibited from sharing their patient’s records unless there is a court order to do so. Therefore, state law takes over HIPAA in this case.

Thus in states where patient information protection laws are not fully implemented then in such states HIPPA takes precedence, at the same time it will not stop states from coming up with legislations that offers a far greater patient privacy protection provisions.