Insurance coverage is wonderful because it allows patients to access chiropractic services—but what about the instances when your chiropractic claims are denied or delayed?
Health insurance does not seem so great when this happens. It can be downright frustrating to file claims only to see them rejected later. Even worse, these bad claims can prevent you from being appropriately compensated for helping your patients.
No clinic can stay afloat if too many claims fail. Providers who know how to combat and prevent this type of financial free-fall will probably fair better than their peers and ultimately provide better care for patients.
So, how do you recognize a bad claim? Keep reading for the top five reasons chiropractic claims are rejected or delayed. Although these are listed in no particular order, each one can cause havoc to your business. You should try to avoid making these mistakes, whenever possible—if you cannot, your business may suffer!
1. Insufficient documentation or none altogether
If your claim has the wrong supporting documentation, your payment could be delayed or completely rejected. Insurance companies have very specific rules for coverage, of course, and claims must establish the necessity of patient care, the fact that it was provided to the patient, and any outcomes and follow up that are expected according to standards of care for your profession, local area and the insurer.
Keeping documentation complete helps prevent problems with payment and also keeps inconsistencies at bay, allowing you to successfully keep your claims paid and efficiently processed.
2. Coverage problems in the patient’s plan
Certainly, there could also be problems with a patient’s insurance plan, too. This can manifest itself in a variety of different ways. For instance, your patient may not actually have current insurance coverage even if they think they do. Their plan may not cover chiropractic care, or they may be wrong about how many visits or the types of visits that are actually covered.
Verifying your patient’s insurance before providing care can help minimize this problem. It is best to have all insurance issues sorted before bringing on a new patients, and regularly check eligibility for existing patients. It is a good habit to check patient insurance coverage for changes once a year.
Even if your patients do not notify you of any changes, it is a good practice to gather your own information before you fall into insurance problems.
3. Wrong payment
Sometimes denials happen because the payment is wrong. If you are billing for the wrong amount, the insurance company may just reject the payment or delay it altogether. To prevent this from happening, you may need to review your billing process or enlist the help of a clearinghouse to check your claims and process them.
4. Coding errors
Coding errors are a reality of the billing process, particularly if you are using paper billing, relying on templates and not checking your work before sending them off. This is where outsourcing your billing to an experienced service or using a clearinghouse can help. Electronic billing is frequently standard now, but many practices still rely on older methods (i.e., paper) that can hold them back.
5. Human verification and processing.
Billing that requires human verification or processing at the insurer may also cause approval delays. It is important to be polite when contacting the insurer, since kindness to the human decision-makers can sometimes encourage another review of your claim.
Try contacting the company to see where the problem is. Work to quickly resolve the issue, if possible, or thoroughly examine the claim for errors after a rejection.
What to do
Since a significant percentage of claims may be denied completely, it is a good practice to regularly spend a minute or two on each claim before sending it for approval, rather than potentially waste 20 minutes or more resolving a denied claim. A chiropractic clearinghouse can also help you reduce the amount of claims that are denied or delayed by taking out the guess work.
Study denied claims for errors and work to quickly fix any mistakes in future claims. If the same mistakes happen consistently, see if you can identify the circumstances that create these mistakes. Is your billing team too busy? Are claims reviewed before submission? Are most claims paid in 45 days or less? What percentage of claims are never paid?
Look for commonalities among the rejections and delays, whenever possible.
- Necela, Tom. “The Top 6 Reasons Your Chiropractic Claims are Denied, Delayed or Paid Incorrectly.” The Strategic Chiropractor. https://www.strategicdc.com/the-top-6-reasons-your-chiropractic-claims-are-denied-delayed-or-paid-incorrectly/. Accessed: Jan 2018.
- ACOM Health. “Top 7 Chiropractic Billing Tips for Increasing Monthly Revenue.” ACOM Health Blog. https://acomhealth.com/top-7-chiropractic-billing-tips-increasing-monthly-revenue/. Published: Jun 2017. Accessed: Jan 2018.