Insider Secrets For Better Reimbursements

You have just spent an hour with a 67-year-old female patient who is complaining of chronic neck and back pain. She also relates a history of osteoporosis and was involved in a recent automobile accident that caused her head to be whiplashed. You performed a thorough consultation and comprehensive chiropractic examination.”

Your findings reveal the clinical need for chiropractic care to consist of manipulative therapy to the cervical, lumbar and sacroiliac joints (CPT code 98941), electrical muscle stimulation (97014), therapeutic exercise instruction (97110) and soft tissue mobilization (97140) for one month at three visits per week. Your examination results also find the need for some diagnostic testing. You recommend X-rays, a bone density measurement study, an arterial doppler study and a soft tissue ultrasound scan.

Wouldn’t it be nice if you gave insurance company this information and they said, “Go right ahead; we agree with your assessment and we’ll pay for the recommended procedures.” This scenerio is not “fantasyland.” If you follow these recommendations, you will have a much better chance of getting insurance companies to pre-authorize treatment, even before you start care.

Patient Verification Form

Your first step should be to start with a super-efficient Patient Insurance Verification Form. The form should cover the following questions:

• Does the policy cover Chiropractic Manipulative Therapy (CMT)? If not, DON’T HANG UP! Ask if it covers physical examinations, X-rays, and all other procedures that you perform except for CMT.
• If it does cover CMT, at what percentage?
• What’s the deductible? And has it been met?
• Is there a CMT visit limit?
• Is there a dollar limit?
• If a particular procedure is not covered, can you accept payment directly from the patient? If not, you should ask to see the insurance policy handbook describing this regulation. If you can accept payment, does the patient have to sign a consent form?
• Can benefits be assigned directly to the doctor?
• Where do you send the claims?
• Can you become a participating provider?

Are the following services covered:

• CMT-98940, 98941, 98942, 98943
• Manual Therapy Techniques-97140
• Soft Tissue MassageTherapy-97124
• Therapeutic Exercises-97110
• Neuromuscular Reeducation-97112
• Hot/Cold Packs-97010
• EMS-97014
• Paraffin Bath-97018
• Diathermy-97024
• Therapeutic Ultrasound-97035
• ROM Measurement-95851
• NCV-Sensory-95904
• NCV-Motor-95903
• Therapeutic Activities-97530
• Diagnostic Ultrasound-76880
• Self Care Training-97535
• Muscle Testing-95831
• Consultations-99241-99245
• Arterial Doppler-93922
• Bone Density-76076
• Any other procedure that will be performed in your facility
• What’s the name and extension of the person providing the information?
• Additional comments?

Putting It in Writing

Next, you should write a quick, one-page summary of what you found and what you want to do.

Here is a sample:

Using the form on the previous page, a client requested authorization for four weeks of treatment and diagnostic testing. This was the actual response from the insurance company before care started:

Receiving a response letter from the insurance company like this one is essentially “money in the bank.” This is as close to getting “pre-paid” as possible.

Although many chiropractors perceive insurance companies as “the enemy,” the fact is, they are not going away. So, you’re left with two choices: Number 1, start an all cash practice; or Number 2, make the insurance companies your “friends.” Well, maybe not friends… how about just acquaintances?

The point is that you should, from the very first visit, open up a dialogue with the insurance examiner assigned to your patient’s case. Relate to that person that you want to get the patient discharged from active care as soon as possible. Tell the examiner you will be keeping him or her updated on the patient’s progress and will be providing summary reports at least once per month.

Try these “insider secrets.” And don’t be surprised if you start getting paid faster and better.