February 2003

FCA, OSCA, ACA work to resolve billing errors

Through attention to detail and reports of claim payment concerns, progress has been made to identify and solve reimbursement errors for doctors of chiropractic in Florida and Ohio. The Florida Chiropractic Association (FCA) and the Ohio State Chiropractic Association (OSCA) worked with American Chiropractic Association (ACA) to pinpoint these errors.

United Healthcare (UHC) has been very responsive to the concerns. Some of the denials involve limited coverage dictated by self-insured employers. In this case, UHC simply handles the processing of claims and does not determine the level of coverage. In other situations, an adjuster and/or computer error occurred where double co-payments were deducted and independently billable codes were bundled.

Most often the errors centered on double co-pays on the same date of service and bundling of Physical Therapy/Manual Therapy with Chiropractic Manipulative Therapy (CMT) codes (CPT Code # 97112 Neuromuscular Reeducation and CPT code # 97140 for Manual Therapy).

National UHC officials have identified all co-pay claims that have been processed in error. Payment will be made within the next 3-4 weeks. Doctors will not have to file an appeal or resubmit any claims, however, denials for Physical Therapy Services will need to be resubmitted.

Chiropractors can cut down on future claim payment errors by including modifier '-59' when billing Manual Therapy, CPT code #97140. CPT code #97140 can only be billed when performed to a separate body region than the CMT service.

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