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     Complete Acupuncture and Chiropractic Billing and Collections

 

 


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 A Better Level of Service

Billing for services is much more than printing up a claim and sending it out. Billing is about reimbursement, getting the money to the office and getting it there as quickly as possible.

Billing is about the patient. We "take care" of the insurance billing for our patients as a courtesy to them.   As alternative practitioners we establish a relationship with our patients. Both acupuncture and chiropractic services require multiple visits for effective results and healing.  We get to know our patients, unlike other medical specialties.  We want patients that refer, we want patients for life. That requires providing a better level of service.

Our Service Begins with ACCURATE Verification of Benefits

A lot of billing services don’t offer verification, and it’s obvious why,   IT TAKES TIME!   Plus not all verifications will result in an insurance patient.  Some billing services don’t want to take the time verifying coverage for a patient that can’t be billed.  We feel differently.  We want to do it, and we want it done right. This is a service we provide out clients and it must be done correctly whether we end up billing the insurance carrier or not.

Accurately verifying coverage requires spending lots of time on the telephone. While some Insurance carriers offer fax back verification or online benefit checks we’ve found it is usually not specific enough to accurately verify acupuncture and chiropractic benefits. We’ll use it for certain carriers, but for the most part we make a call, or two, or three. It is not unusual for us to confirm coverage with a number of different representatives, and it's all done for specific reasons.  We’ve had benefits quoted, not once but three times Only to find the representatives "made a mistake”. Because we were quoted benefits (and they were recording and noted by the carrier) we were able to be successful in appeals to get the benefits quoted for our patient, not what it turned out to be his actual coverage. Secondly you need to know whether  you are dealing with an actual insurance carrier, or if  the carrier is acting as an administrator for a self insured plan.  Each type falls under different categories governed by different laws.

It Continues With Getting the Claim Out as Quickly as Possible.

Every billing service utilizing electronic filing, EVERY service. What they don’t tell you is not every claim can be sent electronically.  All work comp claims go paper, a lot of smaller self-insured plans will not accept electronic submissions. Some carriers will only accept electronic claims for in-network providers.

During normal business hours we send out all claims with 24 hours of receiving them, both the electronic AND the paper claims.

In cases of patients with multiple insurances, (primary and secondary) we send all acupuncture claims that have Medicare as primary to both carriers at the same time. A lot of secondary carriers realize that Medicare does not cover acupuncture so we can turn a denial around with a phone call, and if we can’t we know that a denial is being created that we can request and submit  knowing our claim is already in the secondary carrier’s system.

We also stay up with code changes. In the last 20 years we’ve seen chiropractic codes change twice. When acupuncture codes changed in 2005 we were ready.  Experience taught us that not all carriers would be accepting the new codes during the first of the year. We instructed our clients to sit tight we would continue to utilize the old codes until we sure that each carrier was up and running with the new codes. That made a big difference. Sure, we received more denials than we usually do, but we saw many fewer claims than services/offices that made the switch to all carriers.  Over and over we heard stories of denials of the new codes, old news to us. As each carrier made the switch, we did too.. Was it more work for us? Yes, A LOT. But experience told doing it this way would keep reimbursement flow to our offices.

Experience also helps us in the work comp arena. For example, in the State of California Federal worker’s compensation uses different codes than State Worker’s compensation which uses different codes that regular insurance. We’ve cleaned up claims where an office got authorization to treat a W/C patient, but then billed using codes that weren’t authorized or codes that aren’t recognized. It’s the reason we like to be part of the authorization process. Just like with insurance verification, we have the experience to help get the authorization that will match with the bills we submit.

Double checking Explanations of Benefits Completes the Process

Benefits have been double checked, accurate claims have been submitted. A good percentage of claims are still going to comeback incorrectly paid, and guess what? It’s almost always in the favor of the insurance carrier. We don’t just resubmit the same claim again, expecting a different result. We make another call to the Insurance company. We always follow up with a paper trail, sent both via fax and mail. Over the years we’ve collected the fax numbers of a majority of the insurance carriers, (something they don’t just give out) but we don’t rely on that alone. So it’s a phone call, a fax (when possible) and a written request for reprocessing.

Finally Working Your Aging

This is another area where experience is beneficial. We’ve sent your claims electronically, we know this insurance carrier usually pays in 14 days, two weeks go by, we make a call. Electronic claims submission is not infallible. Clearinghouses will tell you, they’re not sure why but sometimes they don’t receive electronic submissions that show as having been received. Mail is even less reliable. True insurance carriers are subject to interest penalties, for slow pay, they generally pay quicker and that is why they all accept electronic submissions. Self-insured are also required to pay on a timely basis but there are no penalties they are required to pay. We take all these things into consideration when submitting a bill and awaiting payment







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