Chiropractic Medical billing services for Medicare Claims

An increasingly a large number of chiropractors are choosing to outsource their billing and coding tasks. Hiring a quality billing service is one of the most important decisions you’ll ever make regarding the business aspect of your practice. It is crucial that your chiropractic billing company has the experience necessary to handle the complexities presented by Chiropractic billing and modifiers.

Experienced medical billing companies provide chiropractic billing services to ensure compliance with payer mandates, ensure appropriate claim reimbursement. When it comes to Medicare payments, things can get quite complex as Medicare has several requirements that chiropractors must comply with.

By outsourcing medical billing to a reliable service provider, chiropractors can rest assured that their practice meets Medicare requirements for documentation, coding and billing for proper payment, avoiding denials and paybacks.

There are some changes to Medicare billing for chiropractic services in 2017, which makes such support even more critical.

Medicare Coverage for Chiropractic billing services:

1. Medicare coverage of chiropractic services is limited to manual manipulation of the spine to correct a spinal subluxation. There is no separate payment for the device.
2. Medicare pays for acute care or active treatment.
3. Medicare Part B covers the chiropractic services provided by a qualified chiropractor who is licensed and authorized by the State or jurisdiction in which the services are provided.
4. Medicare does not cover chiropractic wellness care, maintenance care, or preventative care.
5. Medicare does not cover extremity (hip, knee, foot, wrist, elbow, etc) adjustments, examinations, X-rays, therapeutic exercises, deep tissue work, ultrasound or electronic muscle stimulation.
6. When no longer in active care according to Medicare guidelines, the patient will be moved to maintenance care. In this case, payment for maintenance services becomes the patient’s responsibility.

Essential Documentation for Medicare payments:

1. In addition to history and description of illness, the physical exam evaluation and management (E/M) documentation should include vitals, spinal evaluation, neurological and orthopaedic evaluation.
2. The mechanism of trauma must be clearly documented. If the patient cannot correlate the mechanism of pain to any specific activity, this must be mentioned in the initial documentation.
3. To affirm that all documentation required by Medicare is being maintained on file, the chiropractor has to affix the date of the initial treatment on the claim.
4. Services provided during the initial and subsequent visits must be documented as to meet the Benefit Manual and the applicable Local Coverage Determinations (LCDs) for chiropractic services.
5. The precise level of subluxation should be specified in order to validate a claim for manipulation of the spine.
6. The primary diagnosis must be subluxation, including the level of subluxation. ICD-10 code M99.0 is appropriate to report segmental and somatic dysfunction.
7. The documentation of the treatment plan should include a recommended level of care or duration and frequency of visits. For duration of care, Medicare expects episode of care details, that is, a beginning and an end of care. Though projecting the actual duration of care is difficult, this must be done as best as possible.

Based on the number of spinal regions treated, chiropractors may bill Medicare for chiropractic manipulative treatment using one of three Current Procedural Terminology (CPT) 11 codes:

• 98940 – For treatment of one or two regions.
• 98941 – For treatment of three or four regions.
• 98942 – For treatment of all five regions.

All Medicare claim submitted are audited/reviewed to protect Medicare trust funds and also to identify billing errors. According to the Office of Inspector General Report, the Center for Medicare and Medicaid Services (CMS) has announced that provisions for oversight include requiring preauthorization of services provided by chiropractors with aberrant billing or high rates of denials.

The best way to understand Medicare coverage, reimbursement, and billing requirements and avoid audits through proper coding, documentation and claim processing practices is to partner with an experienced chiropractic medical billing company.

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