How To Bill For Integrative Medicine Services

Making the courageous decision to build an integrative medicine clinic that advances health in your community, requires advanced and complex strategies to getting paid for those services. Many clinics outsource to an integrative medicine billing services company to assist them, but quickly become disappointed in the results. An integrative medicine clinic cannot just dump their collection problems on a billing services company. The integrative medicine clinic must employ the expertise of a billing services company adept at integrative medicine services, but the clinic must also employ strategies and processes within the clinic that vary based on the likelihood of third party reimbursement. 

If you started out as a chiropractic clinic or a traditional medical clinic, the complexity of combining chiropractic, medical and holistic services often overwhelm the clinic’s billing department and the traditional chiropractic or medical software is often not equipped to handle this complexity. Coding and submitting medical claims with 85 data entry points requires high level coding skills. Consider that the Office of Inspector General (OIG) conducted an audit proving that 82% of chiropractic claims have errors on them. https://oig.hhs.gov/oas/reports/region9/91402033.asp  Adding both traditional and experimental medical services to a chiropractic billing department with an 82% error rate without substantially changing the billing department systems is a recipe for financial failure.

The challenges do not end there. Most chiropractic clinic software does not include the ability to quickly and efficiently document the medical necessity data points for services that chiropractors cannot do. Moreover claim creation becomes a tedious process if the software does not anticipate your needs to document medical services. For example, if a joint or trigger point is being injected, the provider of that service has to be able to input the NDC number and drug off the bottle into the software. This needs to occur within seconds by the provider and be listed in both the treatment note and on the claim.

Regenerative medicine services are often one of the services offered by integrative medicine clinics. Traditionally, regenerative medicine services are cash services. Many integrative medicine clinics mistakenly assumed that regenerative medicine services did not require as much documentation since there was no 3rd party payer scrutiny. They failed to understand that regenerative medicine services receive a higher level of scrutiny from the providers licensing board because of being experimental and considered an outlier medical service. Documenting these services poorly puts the providers license at risk. The integrative medicine software has to provide extra documentation protection, not less. A paper system takes too much time and often lacks the medical necessity data points supporting the service.