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The biggest headache from taking any insurance is submitting the request for payment.
Those payments may take a while to get back to you, but making sure you do it right the first time can reduce the frustration of not getting paid at all.
However, if you know how to do it right, you can save yourself a lot of time and headaches.
Let’s review some things to look for when billing chiropractic DME to make your life easier.
What is Chiropractic DME?
Durable Medical Equipment (DME) are items your patients can take home and use that will help improve their health under your guidance.
As a chiropractor, you have many options, from braces to orthotics to cervical traction to any number of devices.
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These tools can increase your patient outcome, helping to relieve pain and discomfort faster.
They can also increase your bottom line, increasing the amount of revenue coming into your clinic and the profits you see.
Why is DME Helpful for Your Chiropractic Practice?
When you follow the best practice guidelines for using DME, you open yourself up to various tools and equipment to help your patients and practice.
The ROI for these devices has a wide range, with some of the top generators bringing several hundred to over $1,000 into your practice.
But it’s more than that.
This DME helps your patients remain active in their health care.
Braces and orthotics can remind your patients to keep specific postures and activities they might not remember otherwise.
The use of an orthopedic pillow can give your patients a better night’s sleep than they’ve had in years.
And the back brace might relieve pain giving your patient the ability to move without pain.
When your patients succeed, they spread the message.
Happy, pain-free patients will tell other people, which will help draw in more people for you to help.
It’s not just a short-term ROI these individual products give you.
The benefits are the long-term goodwill you build up by helping people feel better and teaching more people to be healthy.
Overview of Billing Chiropractic DME
As a chiropractor, you got into this to help people feel better.
It’s a lucrative industry, but the real benefit is making people happy and healthy.
But, if you don’t get paid, you’re not going to be able to help anyone.
So, taking a look at the proper steps to billing chiropractic DME is essential to do correctly from the start.
The first thing you’ve noticed is billing and coding are not universal.
Most insurance companies follow Medicare’s guidelines and will mostly adhere to what they have to say.
Some will add their stipulations, and some will loosen the restrictions, so navigating the exceptions is a significant benefit.
These codes contain five alpha-numeric characters that describe all the evaluations, diagnostic tests, and tens of thousands of medical procedures.
Private insurances can add to these codes.
You won’t be able to evade their use.
Even if you choose not to participate in the Medicare system, you still must adhere to their guidelines.
Just knowing this is important.
The fines can be in the tens of thousands range, possibly more.
Then, you have the crucial distinctions between private health insurance, automotive insurance, and workman’s comp for third-party payers.
And finally, a whole other class of self-pay people takes complete responsibility for their payments and health coverage.
It becomes challenging.
7 Key Elements
There are 7 key elements that define the critically necessary steps for a payable claim:
- Medical Necessity
- Services Were Provided
- No Statutory Violations (Stark Law, Federal Anti-Kickback or a False Claims Act Violation)
- Meets All Coverage Rules Set By Payer
- Full and Complete Documentation
- Proper Coding
- Proper Billing Practices
Not following these rules could set you up for an audit, particularly by Medicare.
One of the biggest red flags is incomplete documentation and improper coding.
The only chiropractic CPT codes covered by Medicare are 98941, 98942, and 98943.
All other CPT codes billed to Medicare will be denied.
That makes using the correct code and documentation much more necessary.
When it comes to billing chiropractic DME, pay attention to what you prescribe.
Medicare will only cover that which is medically necessary and only obtainable through a medical professional.
Some braces, orthotics, exercise equipment, and maintenance equipment can cause problems, and they can say it’s not medically necessary.
Medicare NCD 280.1 states: “Deny – not primarily medical in nature (§1861(n) of the Act).”
Another policy states: “Home exercise/PT equipment that can be obtained without a prescription is considered to be an over-the-counter supply, is not considered DME, and is, therefore, ineligible for coverage.” So, even if you prescribe weights, bands, or exercise balls for therapy, it can be obtained without a prescription, making it ineligible for home use.
But, using it in a regular therapy session is acceptable.
You may want to notify your patient of the non-covered DME, especially if they wish to continue the exercises at home.
They can complete an Advanced Beneficiary Notice (ABN).
Even if you don’t want to take Medicare, you can’t opt-out of it.
You still have to follow the rules.
Those rules are even harder because reimbursement and the necessity for treatment can fluctuate between state and region.
Be sure to access the current Medicare fee schedule for your area.
Auto insurance usually covers most devices and procedures, expecting the best results as fast as possible.
However, the results are necessary, as is the proper documentation.
You may have more leeway with billing chiropractic DME than other insurances, but you need to make sure they will be covered.
With a vast number of auto insurance companies, be sure to check before prescribing.
Workman’s Comp Insurance
While lucrative and very beneficial to your patients, there’s a bias that and belief that chiropractors, among other medical professionals, will extend treatment beyond proper healing and not refer patients to other medical professionals when necessary.
That means you will need to be extra careful in your documentation and prove that your service is medically necessary and that your patients improve with each visit.
In addition, many workman’s compensation regulations place limits on chiropractic care and may refuse payment.
Different compensation may happen depending on the type of work your patient performed and their viability to reenter the workforce.
You need to understand your patient’s insurance coverage before treating them.
The same company may have different versions of the insurance contract, and it can offer different reimbursement.
Checking eligibility before the appointment will make sure you get paid.
Surprisingly (or not), eligibility and reimbursement can and will vary depending on your state and locality.
Private insurance is the most complex.
However, many larger insurance companies do what they can to make the preauthorization process as easy as possible.
Many companies offer webinars and seminars to teach new chiropractors and billing employees how to use the system correctly and efficiently.
Taking advantage of this help is truly in your best interest.
These people pay for their needs personally.
Fortunately, you don’t need to know medical billing to take cash payments.
However, you may need to work with them to establish the ability to pay.
Knowing the actual cost to your clinic for the DME and the time-cost of billing the insurance companies, you can establish a reasonable payment for DME for cash pay.
Usually, that will be significantly less than what you charged the insurance companies.
Best Practices And Medical Treatment Guidelines
For the most part, you can talk about the best usage of DME for your practice and how to handle the conditions you were presented with.
The DME are tools for you to use to increase your outcomes and make your patient’s life easier, but they should only be used when necessary.
The American Chiropractic Association has a thorough explanation of proper guidelines and rules and regulations chiropractors should be following to make their practice as safe and productive as possible.
But this is multifaceted.
Real World Example
Taking this real-life example from a friend, we can see how complex billing can get.
A patient came in with neck pain, something very common.
Upon examination, we found the patient’s hips in excess nutation and one foot pronated.
But, no pain was presenting lower than the neck.
A standard course of treatment for neck pain was prescribed, and so were orthotics.
This would help adjust the excess nutation, which relieved the pronated foot and the neck pain.
Under the private medical insurance guidelines, orthotics weren’t accepted as part of treatment for neck pain.
Had the chiropractor submitted that claim, it would have been rejected.
So, the additional diagnosis of the foot imbalance allowed the prescription of orthotics.
While this chiropractor did not lie or invent a problem, which is unethical, they were simply treating the patient as they should.
What the chiropractor did was list out separate facets of one problem to achieve the same results.
Billing is intricate, and using some of these simple suggestions can help you navigate the confusing path you need to get proper reimbursement for your services.
DME is part of the future of health care and chiropractic care, as are many conjunction services such as nutrition, massage, and other holistic services.
Expanding your practice keeps you on the cutting edge of care.