Nearly Half of DCs Report Negative Experiences With Billing Services
Our recent Dynamic Chiropractic PracticeINSIGHTS poll asked: "What is your experience with billing services?" While almost one-third of respondents (30 percent) had no opinion either way, almost half of clinicians who took the time to respond had either a negative or a very negative opinion (48 percent), and felt that billing services just couldn't adapt to what their specific office needed.
Roger De Sesa from California said, "The billing company I hired decided to bill everything under the sun, even though I mostly provided a CMT 98940. When the EOBs started coming in, and my $50 visits were billing out at $300, I found myself spending hours answering to patients who were furious. I fired the billing company and refunded money back to the insurance companies. It was an embarrassment and caused me stress and worry for a year after the event. I have kept my billing in-house since then."
Robert Chatfield, also from California, said that he has "used four different services over the years, and none did as well as when we collected our own money."
However, not everyone who responded to this question has had a negative experience utilizing billing services. Jonice Owens from Emeryville, Calif., said she had a "very positive" experience with her billing service.
Howard Brown from Wappingers Falls, N.Y., said that he "began with Chiropractic Management Services (CMS), from upstate New York, years ago. I did have a full-time employee on billing, which is necessary when dealing with New York State insurances. CMS replaced her, cleaned up unpaid claims and our prior errors, and offered improvements to our own billing system. The cost is about equivalent to the prior employee, and it's even better when you consider the greater amount collected."
Perhaps the most important key in determining whether to utilize a billing service is to understand your own practice needs and whether or not what the billing service offers is right for you. It pays to do your own research and ask the right questions in order to make the best decision for the future of your practice.
6 Solutions for Common Billing Errors
Whether you're doing your own billing or outsourcing it, if it doesn't get done properly, your chances of being fully reimbursed (if at all) for your services will be greatly diminished. Here are six common billing errors courtesy of Samuel Collins, director of the H.J. Ross Network:
When billing for an examination (evaluation and management codes 99201-99205 and 99211-99215) done on the same day as treatment, the evaluation and management code must be appended with modifier 25. This modifier is to indicate the exam was separate and distinct from the treatment done. If the modifier 25 is not included, the exam services will not be paid and noted on the explanation of benefits as included in the other services billed.
If the patient did not pay in full for their services at the time of the visit and you are billing an insurance claim on their behalf, be sure that block 13 of the CMS1500 is signed or indicated with "signature on file." This block is the assignment-of-benefits portion of the claim. When it is signed or indicated as "signature on file," the payment will come directly to the provider. If it is left blank, the payment will be directed to the patient.
When billing a claim, there must be a date included in block 14 of the CMS1500. It is not acceptable for it to be blank or to have a nonspecific date. It must include the month, day and year. This will be the date of injury, date of first symptom or the first date the patient presents to the office.
When billing on the CMS1500 form, both blocks 32 and 33 (the place where services were rendered and the billing location or facility) must have the full name and address. It will cause a denial if one is left blank or states "same."
On the CMS1500 form, block 21 is space where the diagnoses are indicated. There are four places for diagnoses, and they should be the specific ICD-9 numbers. It should contain only the numbers with no narrative descriptions. It is paramount that those numbers be complete to the highest level. This means that if the diagnosis is missing a digit or has an extra digit, it will be denied. Even if only one of the four diagnoses is coded incorrectly, the entire claim will be rejected.
If you are billing for a 3-4 region (98941, manipulation) or 5 region (98942, manipulation), you may notice there are not enough spaces in block 21 to include all the diagnoses necessary to qualify for the level of service since block 21 only has four spaces. The additional diagnoses would be placed in block 19. Simply add the diagnosis codes, separated by a comma.
Some doctors thrive in a personality-based clinic and have a loyal following no matter what services or equipment they offer, but for most chiropractic offices who are trying to grow and expand, new equipment purchases help us stay relevant and continue to service our client base in the best, most up-to-date manner possible. So, regarding equipment purchasing: should you lease, get a bank loan, or pay cash?
Some pundits say that the upcoming presidential and congressional races, and many local races, might be the most consequential in our country’s history. We do not have the choice of sitting on the sidelines and hoping our patients will carry our water. Unlike other medical professions such as physical therapists, podiatrists, nurses, etc., the health care class (AMA) will not protect us. We must be in the game.
The most common condition affecting the shoulder is rotator-cuff disease. From acute tears to chronic tendinopathy, it’s common and needs a thorough workup. In fact, even asymptomatic shoulders can have full-thickness rotator-cuff rears in up to 40% of instances. Let’s look at additional conditions that can present to the office with weakness, loss of motion and pain in the shoulder beyond rotator-cuff tears.
