Chiropractic Billing Revenue Opportunities
Imagine finishing a long day at your practice, only to realize that despite your dedication to patient care, significant revenue might be slipping through your fingers. For many chiropractors, this is a frustrating reality, but recent changes in billing guidelines offer an opportunity to turn things around.
In 2021, a pivotal update to the evaluation and management (E/M) CPT codes was introduced by the American Medical Association (AMA). This change allows practitioners to use the total time spent with a patient as the sole basis for coding certain levels of service, rather than relying exclusively on the complexity of clinical decision-making. This shift is relatively new and may not be widely known among practitioners yet.
Under this new guideline, the time required for each E/M code is as follows: Code 99204, which is used for a new patient visit, requires a total of 45 to 59 minutes spent with the patient on the day of the encounter. Similarly, Code 99214, used for established patient visits, covers 30 to 39 minutes. For more complex or higher-level care, Code 99205 requires 60 to 74 minutes, while Code 99215, also for established patients, necessitates 40 to 54 minutes of time. For those of you who have long exam times, make sure you document and code appropriately, as no one will pat you on the back for under-coding your services.
In our own internal findings at American Chiropractic Billing (ACB), the average chiropractor can stand to gain approximately $13,000 annually by just properly coding their E/M charges. That said, accurate documentation of this time is crucial for reimbursement. A documented range of time will not be sufficient to get you paid. Instead, you must indicate the exact number of minutes spent, and if you don’t track it, then you can’t charge it. This time includes not only face-to-face interactions but also any additional time spent reviewing medical records, coordinating care, and performing related administrative tasks (such as finishing your chart note). It’s important to note that time spent on unrelated activities, such as staff meetings or personal breaks, should not be counted.
In addition to optimizing exam coding, chiropractors can enhance revenue by focusing on active care. Insurance companies generally favor active care interventions, which can be billed using codes such as 97110 for therapeutic exercises, 97150 for group therapy, and 97530 for therapeutic activities. These codes offer favorable reimbursement rates and allow for multiple units per visit when justified. Additionally, where permitted, therapeutic exercises performed by chiropractic assistants can further boost productivity and revenue.
Incorporating durable medical equipment (DME) into your practice also presents a valuable revenue opportunity. Custom-fitted braces and other equipment can be reimbursed at rates exceeding $1,000. For practices dealing with acute injuries from car accidents or workplace incidents, adding DME to your service offerings can be highly profitable.
Adding massage therapy services can further enhance your practice’s revenue, especially in regions of the country not restricted by Relative Value Units (RVUs) per visit. Billing up to four units of Code 97124 for massage therapy can be lucrative, and investing in a dedicated massage therapist may prove beneficial. To maximize reimbursement, it’s advisable coordinate massage services carefully and avoid overlapping with chiropractic manipulative treatments in the same area, but for those of you who hire a licensed massage therapist and are able to bill under the massage therapist’s license, this is a much smaller consideration.
Finally, having a skilled biller on your team is crucial. An experienced biller who understands the intricacies of chiropractic billing can significantly impact your practice’s financial health. This expertise is particularly valuable for managing complex claims related to Motor Vehicle Accidents (MVAs), Workers' Compensation (WC), and other specialized cases.
To fully leverage these revenue opportunities, partnering with a billing specialist can make a transformative difference. American Chiropractic Billing (ACB) excels in optimizing chiropractic billing processes and ensures that every revenue opportunity is captured. Our team seamlessly integrates with all existing Electronic Health Record (EHR) systems, allowing your practice to maintain its current procedures without disruption. By utilizing the specialized services of American Chiropractic Billing (ACB), you can significantly enhance your practice’s financial performance and ensure that no revenue goes unclaimed.
American Chiropractic Billing (ACB) does not provide medical advice, diagnosis, or treatment recommendations. It is solely the responsibility of the healthcare provider to determine what is medically necessary and beneficial for their patients. The purpose of this article is to highlight potential opportunities that chiropractors may wish to explore to enhance their practice. Providers are encouraged to evaluate these strategies within the context of their unique practice and patient needs to ensure the best outcomes.
Ultimately, adapting to these billing changes and strategies will help translate your dedication to patient care into the financial success your practice deserves. By embracing these opportunities, you can ensure that every adjustment and every patient interaction contributes to both improved health outcomes and a healthier bottom line.
If you're interested in optimizing your practice's billing processes and maximizing your revenue, American Chiropractic Billing is here to help. For a personalized consultation, call us today at 1 (888) 498-5848.
