Insurance Archives - Chiropractic Billing And Coding

New Medicare ABN Approved

A new Advanced Beneficiary Notice (ABN) has been made available. Starting 08/31/2020 this new form becomes mandatory. The ABN is a written notice given to the Medicare patient to inform him that Medicare may not pay for an adjustment which is usually covered but may not pay because it is not medically necessary. A patient […]

Billing Spinal X-Rays

Full spine x-rays are not considered to be of diagnostic quality. This is expecially true of 14×36 film. So if a chiropractor decides to x-ray the patient’s entire spine, he should take sectional views and bill the exam using three codes as follows: 72040 Radiologic examination, spine, cervical; 2 or 3 views 72070 Radiologic examination, […]

GP Modifier for Therapies

Insurance policies are written in segments or riders. Chiropractic services are covered under the chiropractic or physician portion of the policy but therapies are generally covered under a therapy portion. The therapy portion of the policy covers all therapy no matter who provides the service. This means that when a patient comes to you they […]

Tax ID, NPI, UPIN, PTAN, Provider and Taxonomy Numbers

Zero State Before you begin treating patients, you should setup the structure of your practice. First off, you should decide if you want to incorporate. A corporation provides a layer of protection for your assets. The laws governing incorporation vary state to state and there are multiple types of corporations so this decision should be […]

Modifiers 25 & 59

Modifiers are used to indicate that a service or procedure that has been performed has been altered by some specific circumstance but has not changed in its definition or code. Under normal circumstances, an Evaluation and Management service (E/M – exam) is filed without a modifier (99203 in this example). However, […]

Fees for Copying Records

All office records, test results, x-ray films etc. are the property of the clinic. The doctor is required by law to maintain the records for a period of time after the course of treatment has expired. Patients may request and are entitled to copies of their records but not the originals. This includes x-rays! Typically, the […]

CMT And E&M On The Same Visit

The chiropractic manipulative treatment (CMT) includes a pre and post service evaluation. The insurance companies, to their advantage, interpret this to mean that the “pre and post service” constitutes an Evaluation and Management service. When a CMT and E&M occur on the same visit/day, they will generally pay the least expensive service (the CMT) and […]

Paper Claim Printing Standards

Insurance companies use optical scanners to read paper claim forms and convert the information on them into an electronic format. This prevents the claim from having to be keyed into the computer by hand. Scanners can read approximately 2500 claims per hour and they have a 97 to 98 percent accuracy rate. Claims must meet […]

Indicating Assignment on the Claim Form

A short definition of assignment is, “who gets the money | insurance check | EOB.” The insured is the beneficiary of the insurance. In order for you to receive the insurance payment from the insurance company, you need permission from the insured (or other authorized person usually the spouse or parent). Accepting Assignment The insured […]

VA Claims

Chiropractic services are part of the standard Medical Benefits Package available to all eligible Veterans. However, there are a few rules you need to be aware of when filing claims to the VA. In general, since this is a federeal government program, the claim should follow many of the Medicare Guidelines: The type of insurance […]

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