Part of running a successful chiropractic office is understanding how to bill for services. This is especially important when you work with Medicare or insurance companies, because improper billing can result in a denial of your claim. In order to receive payment for the chiropractic care you offer, you'll need to set up a system to bill the proper organization. You'll also need to know how to bill patients for any balance due once you've received payment from insurance companies.
Learn the diagnostic codes for chiropractic services. Organizations like Medicare and insurance companies require diagnostic codes, as well as the amount you've charged for each service, before they will process a claim. You can find diagnostic codes at the Chiropractic Resource Organization. Some doctors prefer to purchase chiropractic patient management software with updated codes embedded into the software's database, which simplify your billing process. Some office management systems include electronic billing options, which cut down on the cost of office supplies like claim forms, envelopes and stamps.
Start with the medically necessary diagnostic codes accepted by insurance companies and Medicare. The definition for this can be subjective. You might think a hot/cold pack is medically necessary where an insurance company may not; however, most companies that cover chiropractic services will agree a manual manipulation is medically necessary. Start with the most essential diagnostic codes and work your way down. Keep in mind some companies limit the number of manipulations or codes you can bill for related to a single visit.
Work with insurance companies listing you as an in-network provider. Find out what the billable amount is for each service. While you can bill more than this amount, you'll have to write off any amount surpassing the provider rate established by the insurance companies.
Submit claims to the appropriate place. When you work with insurance, you'll need to get the claims address off the insurance card for the patient. Send in the appropriate claims forms or follow procedures to submit an electronic bill. If the insurance company disallows a specific code, try to resubmit the bill using a different, but applicable, diagnostic code.
Bill your patients for any remaining balance due after you've received payment or information from insurance companies. Insurance companies will notify you when a patient hasn't met the deductible, which means you need to bill the patient for the amount allowed by the insurance company. Make sure you don't bill the patient for disqualified amounts based on your provider rate with the company.
Establish your prices for time of service payments or private payments. Some chiropractors offer a time of service (TOS) discount, meaning the patient pays for the service at the time of the appointment. If you work with insurance companies, you'll need to review the policies for TOS payments in order to comply with your provider agreement. Private payments occur when a person does not want you to bill an insurance company.
Keep track of payments received and balances due. Most office management software designed for chiropractors will have systems in place to handle this. Keeping track of this information can make or break your business.
Consider how to handle collections. Sometimes people don't understand how insurance works, and they expect the insurance company to pay the bill in full. At other times, people won't have the money to pay you, or they'll choose not to pay you. When this happens, you'll have to put the account into collections. If you don't want to handle this in-office, you can hire a company to undertake the collection process for you.