I have noticed lately that some payers are not processing my Chiropractic claims according to the patient’s quoted benefits. What do I do to get full payment for my services?
There are many reasons the insurance companies underpay for Chiropractic services – the first step is to triage any denials that are affecting the reimbursement on specific Chiropractic or therapeutic services and determine if there is anything on the claim that can be fixed or amended in order to receive full benefits.
If the denial is non-specific, you may need to contact the payer to inquire why the Chiropractic service was denied and ask what Chiropractic or general policy guidelines they have in place regarding the service that may point out to different coding, modifiers, etc. are required in order for the service to be reimbursed properly.
For example, if you are quoted full benefits on orthotics but the orthotics are denied as non-covered, you may need to inquire about an orthotics policy guideline to determine if specific diagnoses are needed to document medical necessity on the claim.
If you are working with a Chiropractic billing service company, discuss these problems with your account representative and discuss their plan of action and what should be done in the future to prevent receiving reductions for the denied service. If further training is needed on diagnosis pointers, modifier application, etc. on your Chiropractic billing software, contact your Chiropractic billing service or Chiropractic billing software company for re-training or assistance in learning these steps.