Generate Maximum Revenue – A Know-How on Chiropractic Billing

Every clinic that we see these days are busy on its average day. In the meanwhile, when you have a glimpse at a chiropractic clinic, it may top the chart each time. Amidst these more than average number of patients, your staff might experience a burn-out situation. With that being said, a major misconception is that as more patients start to visit, the clinic resembles as if it is loaded with revenue. In reality, their documentation, coding, billing, federal & insurance program requirements and the pending account receivables make it even more difficult to produce an average revenue for a chiropractor at the clinic. The practice has to start handing their office management and billing on the same scale in order to create an effective revenue cycle.

Let us view those problems that every generic chiropractic clinic faces,

Our documentation does not always sufficiently comply with these insurance company and federal requirements.
The patient's plan does not have coverage benefits for the services offered by the provider.
The most common problem is poor coding and inappropriate billing. Coding errors make an frequent ground for denial in these clinics.
Each work is assigned to an individual. It is our mundane, one task at a time sort of work strategy. The staff was not able to cope with changing provisions.
Every day struggle with underpayment or No-payment.

The tips that you should weigh for generating revenue:

Detailed documentation:

Claims require sufficient documentation to be submitted when the adjudication department demands additional information from the provider. When a claim is denied for medical necessity or additional information, we should primarily focus on producing precise documentation. This detailed documentation helps the biller to choose the procedures and diagnosis appropriately on the claim. They also make sure that the provided information complies with LCD guidelines.

Advanced Pre-determination:

There is always a first time for everything. So, it is considered to be a good habit of a practice to get all the required patient demographics and any specific information about their insurance too. As we all know, chiropractic clinic usually has established patients regularly coming for a follow-up visit. So, it is mandatory to update their information every once in a while. But, for new patients, we should be careful about verifying their coverage benefits, their type and number of visits that are covered. Most of the commercial insurances are asking for prior authorization to process the claim and some insurances are helping providers to obtain retro authorization that can be obtained within 72 hours since the date of service. While completing these predeterminations, we may have to check their eligibility, policy benefits and the right network physicians on their insurance panel.

Examine your denial trends:

A major factor that affects the clinic's revenue is their denied claims. We have observed a maximum of one denial on every four claims submitted and a minimum of one denial for every ten claims submitted. We should list out the common denials like coding errors, name mismatch, prior-authorization, out of network, medical necessity, etc., Assign these denial reasons to separate buckets. Then, analyze the pattern of denials that occur periodically. Create necessary updates to avoid these denial trends in the future. Bring in first-in-class coding accuracy for the documentation provided and comply with the LCD guidelines.

Evaluate your receivables:

In order to evaluate your receivables, you have to know where your maximum receivables are. You have to filter your aging by insurances and their ominous payments. And with that information, you have to divide the aging report by every insurance's timely filing limit. Create a follow-up protocol for every eight days. Our target is to make the average turn-around-time for payment as 25-40 days. Tracking and preparing reports on claims and aging to find out the under-billing and underpaid claims.

The Optimum Billing:

Billing does not have to be common for every practice. But, we should always focus on sending clean claims at a rate of 95%. Your first submission claim should be scrubbed enough to prevent any common denials. After charge entry, auditing does take some more time before we actually release the claim, but it is worth the time, as it is always better to wait for a few minutes before sending the claim than spending hours fixing it. A well-documented record helps the coder to choose accurate codes. Every claim needs appropriate customized coding to make it as a clean claim.

All these above tips are only a few strands on the fine-weaved package. There is yet a lot to unveil. You can use these tips to focus on building a better billing arrangement for revenue generation. Practices can also take advantage of coding software, temporary consultants and virtual vendors assisting to streamline the billing. A transparent bottom line is to produce revenue and to stay consistent about it.

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