Chiropractic Claims Processing Articles and Resources
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by Christine Woolstenhulme, QMC QCC CMCS CPC CMRS
According to the OIG "MEDICARE OVERPAID MORE THAN $636 MILLION FOR NEUROSTIMULATOR IMPLANTATION SURGERIES."
So often we think if we get paid, we must be doing it right, well this is not always the case. You may get paid and then have to return the funds if billed incorrectly or a step ...
Oct 28th, 2021
Understanding ASCs and APCs: Indicators and Place of Service
by Christine Woolstenhulme, QMC QCC CMCS CPC CMRS
The decision regarding the most appropriate care setting for a given surgical procedure is determined by the physician based on the patient's individual clinical needs and preferences. Of course, there is a difference in reimbursement, and the billing depends on where the procedure took place, such as an office setting, inpatient ...
by Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT
Audits are currently underway to verify the monies distributed through the CARES Act were warranted and properly used by those organizations that received them. The federal government has contracted with financial institutions such as KPMG and PricewaterhouseCoopers, among others, to perform these audits referred to as Provider Relief Fund (PRF) audit contractors, funded with monies from the very same program. There were four phases of funding disbursements with phase 1 audits beginning in September. How ready are you to be audited?
Sep 29th, 2021
Injection Services
by Christine Woolstenhulme, QMC QCC CMCS CPC CMRS
Injection Service Codes
Injection service codes, are reported under administration of vaccines/toxoids, using 96372, 90460, 90461, 90471, 90472, 0001A, 0002A, 0003A, 0011A, 0012A, 0021A, 0022A, 0031A, 0041A, and 0042A.
Other injections services include:
Non-antineoplastic hormonal therapy injections – 96372
Anti-neoplastic nonhormonal injection therapy 96401
Anti-neoplastic hormonal injection therapy- 96402
Allergen immunotherapy - 95115-95117
According to CMS, do ...
Aug 4th, 2021
Understanding How Place of Service Codes Work
by Christine Woolstenhulme, QMC QCC CMCS CPC CMRS
The Place of service (POS) codes are used by CMS, Medicaid, and other private insurance to indicate where medically related items and services are sold or dispensed for a patient. POS codes are used for professional billing and are required to be reported on each claim submitted on a CMS-1500 ...
Jun 29th, 2021
Compliance in the Small Practice
by Christine Woolstenhulme, QMC QCC CMCS CPC CMRS
If your practice does not already have a compliance program in place, you will want to get started after reading this article. We have uncovered some important findings with the Office of Inspector General (OIG) in dental practices you need to be aware of. A compliance program offers standard procedures to follow, ...
by Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT
Do you still find yourself searching the internet for an ICD10 code? Medical coders often type into their search engine, what is the ICD10 code for ... and a specific diagnosis code, to avoid repeatedly dragging out the incredibly large ICD10 codebook. Ironically, some of the most commonly searched ICD10 diagnoses include: ...
by Aubrie Rowley
The current coronavirus pandemic refers to COVID-19, a novel or new type of coronavirus known as severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). The first victim of the virus was identified in Wuhan, Hubei, China at the end of 2019. There is no immunization available to prevent it from spreading and ...
Feb 19th, 2020
Q/A: Did Noridian Stop Covering the M99.0- Codes?
by Wyn Staheli, Director of Content - innoviHealth
Question: I heard that Medicare Noridian Jurisdiction F (Alaska) has been denying claims with M99.00, M99.01, M99.02, M99.03 etc codes when billed with the CMT CPT codes. Did Medicare change their policy?
by NAMAS
Anthem has been very busy sending out notices stating that, beginning October 1, 2019, all timely filing deadlines for claims will be 90 days. We've seen this letter, or something very similar, sent to doctors and other healthcare providers from California to Kentucky.
In their notice, Anthem states:
"Effective for all commercial ...
Jun 14th, 2019
A United Approach
by NAMAS
A United Approach
As auditors, we all have a different perspective when evaluating documentation. It would be unreasonable to think that we all view things the same way. In my opinion, differing perspectives are what makes a great team because you can coalesce on a particular chart, work it through and ...
Jun 13th, 2019
What Medical Necessity Tools Does Find-A-Code Offer?
by Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT
Find-A-Code is a great resource for individuals working in all aspects of healthcare, from providers and ancillary staff to the attorneys and payers who assess and critique the documentation supporting the services performed. When recently asked what tools Find-A-Code has to help support medical necessity, our response was, "We provide many resources ...
Mar 1st, 2019
Understanding NCCI Edits
by Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT
Medicare creates and maintains the National Correct Coding Initiative (NCCI) edits and NCCI Policy Manual, which identify code pair edits. When performed on the same patient, on the same day, and by the same provider, the secondary code is considered an integral part of the primary code, and payment for ...
Jul 12th, 2018
Dual Medicare-Medicaid Billing Problems
by Wyn Staheli, Director of Content - innoviHealth
It is important to keep in mind that Medicaid is run at a state level so there can be some differences when it comes to coverage. However, the rules regarding balance billing of covered services is set at the federal level. The law states (emphasis added):
A state plan must provide ...
by ChiroCode™
Q: Are there any alternatives for code 97112 Neuromuscular Re-education? This code is counted toward both Chiropractic and Physical Therapy visits with BCBS, and we want to preserve the insurance benefits.
by Christine Woolstenhulme, QMC QCC CMCS CPC CMRS
When using the JW modifier for Part B drug claims for discarded drugs and biologicals, any amount of wasted material should be clearly documented in the medical record with the following information:
Date, time, and location of treatment
Approximate amount of product unit used
Approximate amount of product unit discarded
Reason for the wastage
Manufacturer’s serial/lot/batch ...
Aug 3rd, 2016
Billing Units
by Wyn Staheli, Director of Content - innoviHealth
Are you billing units correctly? This article outlines important considerations to ensure that claims are submitted properly.
by Brittney Murdock, QCC CMCS CPC
Taxonomy codes are used by insurers as indicators of legal scope of practice. Scope of practice is key to getting reimbursed under the Affordable Care Act or ObamaCare. However, Most providers will only choose one taxonomy code to describe their training. This limits their scope of practice. To maximize scope ...
There are 7 related documentation, coding and billing tips.
Select the title to see a summary and a link to the full webinar information. some webinars require a subscription to view.
Feb 14th, 2023
Use the Right Modifiers for Chiropractic Billing
by Evan M. Gwilliam, DC MBA CPC CCPC CPC-I QCC MCS-P CPMA CMHP AAPC Fellow
Do you really know when to use the 59 modifier? What about the AT? There are relatively few modifiers to consider when it comes to chiropractic billing and coding, but some payers have their own rules and it can be tricky to know when to use one modifier and not another. In this exciting webinar, Dr. Evan Gwilliam, a certified coder, will clear up all the questions you have about the modifiers you need to consider.Jan 25th, 2023
Medical Necessity: it’s far easier to prove than you think, and far more important than you realize.
by Tom Grant DC, Med-Legal Consultant, Pragma Intel Director of Education
Besides coding errors, it’s the 2nd most common tool used by health insurers and 3rd party payers to deny care and deny liability. How do you decide what to use as a tool to prove your care is viable and needed? Expensive equipment and elaborate testing procedures are not what you need. It’s as simple to prove as opening a can of beans, unless you don’t have a can opener. I’ll share with you my insider tips and experience as a medical expert on over 3000 successful PI case settlements and give the can opener that you and your patients need you to use to prove medical necessity, and why you’ll need it in treating what I feel is the next great opportunity for Chiropractic: V_______ care.Jan 11th, 2022
Chiropractic Documentation: The Subjective Element
by Ron Short, DC MCS-P CPC
The Subjective element of S.O.A.P. is where we document what the patient tells us. But what is the best way to gather this information? In this webinar Dr. Ron Short will review the guidelines for the subjective element and explain the best way to gather information from the patient.&…by Ron Short, DC MCS-P CPC
We have all heard of the S.O.A.P. format for our documentation. But what does each element mean and what additional information do we need in our documentation? In this webinar Dr. Ron Short will review the S.O.A.P. documentation format and discuss what additional information you need document. In…by Evan M. Gwilliam, DC MBA CPC CCPC CPC-I QCC MCS-P CPMA CMHP AAPC Fellow
The most commonly used procedure in chiropractic is the chiropractic adjustment, also known as chiropractic manipulative treatment or CMT. There are nuances to the CPT and ICD-10 codes and Medicare guidelines that must be mastered by any chiropractor hoping to find success when creating their…Jul 8th, 2021
Chiropractic Treatment Paradigm 2021
by Ron Short, DC MCS-P CPC
Chiropractic care is different from medical care. We know that but how do we explain it. Reviewers deny claims that are medically necessary because they don’t know what they are looking at when they review our claims. Dr. Ron Short will explain how to approach these reviewers in this…by Brandy Brimhall, CPC CMCO CPCO CCCPC CPMA QCC
August 18, 2020 Join this webinar for a birds-eye review of crucial components of your practice revenue cycle system. Inefficient or unattended revenue cycle systems result in a tremendous loss of time and money for practices. So often, that additional cash flow that practices are seeking, are…Links and resources by topic.
Billing
CMS1500
CPT Coding
Claims Processing
Coding
Compliance
Denial Management
Documentation
ERISA
HIPAA
Hospital
ICD10CM Coding
Insurance
Medicare
Payer Guidelines
Reimbursement
TeleMedicine
UB04 Form and Coding
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