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If it seems like insurers are taking forever to pay the claims you sent them, you are not alone. Plenty of other chiropractors share the same problem. Before issuing payments, insurers typically check policy coverage limits, deductible amounts, and policy exclusions. Moreover, they frequently ask for documentation supporting each claim. And while this has been the status quo for some time, there has to be a better way. Let's look at how to speed up chiropractic insurance claim payments with a few simple changes. Moreover, let's explore how the communication technology you are using right now may actually be creating more problems than it solves.
Understanding the Chiropractic Billing Process
From the onset, your front office team practices due diligence when patients schedule appointments. As part of the intake paperwork, they undoubtedly have the patient sign forms for financial responsibility and the assignment of insurance benefits. Also, your team verifies insurance information to determine if:
- Chiropractic care is covered.
- There is a copayment or coinsurance amount.
- There is a limit to the number of visits a patient may make.
- Your treatment requires prior authorization from the insurer.
- Your patient needs a referral from a primary care physician to your office.
During the treatment, you document the patient's complaints, their medical history, diagnosis, necessary treatment, and progress. You know that this documentation is critical for getting the insurance company to pay for your services. Your team will now transcribe the information using ICD-10 diagnosis and CPT procedure codes. Most small to mid-sized clinics use billing software that automates many of these processes. However, some are not yet on board, making it challenging to achieve consistent data-entry practices.
No matter how you submit your claims, the insurance company may submit a full payment, pay only a reduced amount, ask for additional documentation, or deny the claim outright. For a smaller clinic, any hiccups in accounts receivable can wreak havoc with the cash flow. Would you know how to speed up chiropractic insurance claim payments so you do not have to offer patients a variety of flexible payment options for chiropractors' bills?
How is Your Office's Chiropractic Coding Accuracy?
One of the primary reasons for claim denials is coding accuracy. Because each code represents a standardized diagnosis, your data-entry personnel must use the correct numerical values from the outset. If further specialization of the diagnosis is needed, they can use modifier codes. Once again, it is critical to use the correct ones.
Unfortunately, many mistakes occur at this juncture. Data entry team members may use an incorrect diagnosis code, forget to add applicable modifiers, use outdated codes, or have to set the claim aside due to insufficient documentation. There may also be coding differences between individual team members. In some cases, having a second or third person perform the same data-entry task may result in differences in claim submissions.
A Possible Solution for Coding Inaccuracies
While it is easy to blame the data-entry person, consider the documentation you provide to the team. Is it complete and compiled with an eye on insurance requirements? Moreover, has your team been adequately trained for your clinic's billing practices? Consider conducting periodic internal coding audits. Moreover, review denied claims to identify any recurring coding issues. In some cases, they are easy to trace back to a misunderstanding or a training issue.
Transition From Manual Claim Reviews to Claim Scrubbing Services
Manual claim reviews have your billing team review paperwork before it is filed. The team evaluates the documentation provided for a claim, breaks down complex billing situations, and verifies that the correct coding is used. In contrast, claim scrubbing offers automated validation of your claims with software integration. The application easily detects technical and coding errors. Most importantly, you can have it done before you ever submit a claim.
Transitioning from manual claim reviews to the automated scrubbing option does not have to be difficult. There is now software available that specifies electronic claim tracking, detailed error reporting, and automatic coding edits for chiropractic claims. If you have been automating your office procedures, this software can be integrated with electronic health record (EHR) systems. These systems also allow for the integration of clearinghouse functionality.
A medical claims clearinghouse functions as an intermediary between your chiropractic clinic and the insurance companies. Because there are now so many different insurers offering chiropractic coverage to their members, it is easier to submit all claims to the clearinghouse and have the intermediary route them to the applicable insurers. However, this process is not an automatic guarantee of payment, and your front office team still needs to do some of the legwork.
Clearinghouse Claim Rejection Fixes
A clearinghouse may reject your claims. It typically occurs when the data your office transmits fails the clearinghouse's validation checks. Unlike an insurance company claim denial, this rejection occurs before the claim ever reaches the insurer. If your team reports that the clearinghouse is rejecting the office's claims, check for the most common errors.
- Incorrect patient information. These errors cover anything from misspelled names to invalid insurer member identification numbers. Avoiding this error is possible if your front office team copies each patient's insurance card and works off this copy.
- Incorrect codes. Your team should verify the ICD-10 codes used before claim submission. However, sometimes the problem is with the CPT codes. This problem occurs when your team relies on outdated CPT codes or fails to incorporate payer-specific coding guidelines. This is an easy front-office fix with little more than a code verification.
- Duplicate claims. It gets tricky if you use a clearinghouse and submit claims manually as well. Additionally, if your team is not on top of reconciling the accounts receivable with patient files, the backlog can lead to duplicate bills. The clearinghouse application typically catches this problem before the claim reaches the insurer. However, your team needs to verify that each duplicate claim notation actually corresponds to a paid claim. It is a good idea to have one of your team members be responsible for tracking claim submissions.
How to Reduce Chiropractic Claim Denials at the Clearinghouse Level
The clearinghouse is an excellent tool for catching errors that would typically result in insurer rejections. That said, the system is only as good as the team that works with it. For example, it is critical to review clearinghouse rejection reports daily, correct submissions, and resubmit rejected claim data.
Concurrently, do not neglect to update claim scrubbing software. In some cases, rejection trends point to workflow problems rather than application issues. For example, if rejections consistently occur because of spelling errors, your data entry team member is making too many mistakes. Work with them to slow down a little or do a better job at verifying patient data.
Conversely, if rejections frequently mention code problems, your manuals or billing software may be out of date. Get them updated and ensure that your team only uses the latest updated copies for coding. In some cases, older copies may still be around, making it easy to confuse the coding when temporary workers fill in for someone out on leave.
Better the Odds of Payments Via a Faster Insurance Reimbursement Cycle
Resubmitting claims rejected by the insurer is notoriously slow to resolve. It is possible to achieve a faster reimbursement cycle for a small to mid-sized chiropractic clinic if you are willing to give your front office team extra time. After all, remember that they are working not only with the patient who is currently in the office but also with anyone calling for appointments, information, or other reasons.
If the team is spread too thin or if you do not have employees in several key positions, mistakes will happen more frequently. Ideally, your team members should verify insurance benefits for each patient before each appointment. This is also the time to verify that all patient information is still accurate. At the provider level, it is imperative to ensure that clinical records are complete and include treatment plans, diagnoses, and examination findings.
Just as important is the timeframe for submitting claims. The chiropractic offices most successful at avoiding insurer rejection are those that submit claims within 24 hours of a patient's visit.
Revenue Cycle Management for Chiropractic Practices as an Indicator for Insurance Reimbursement Speed
It is time to pinpoint key performance indicators (KPIs) for the effectiveness of your billing processes. Interestingly, they are tied together with your clinic's revenue cycle. Routinely have a team member review:
- Claim rejection and denial rates.
- Claim acceptance rates after an initial claim submission.
- Outstanding insurance balances that do not offer any status updates.
- Average reimbursement times and overall collection rate.
Faster Insurance Reimbursements Could Rely on Better Communication Technology
When figuring out how to speed up chiropractic insurance claim payments, you notice that there is a lot of work your front office team is expected to do. However, smaller or mid-sized chiropractic clinics typically have only a limited team – sometimes only a receptionist – to handle insurance eligibility verification, electronic claim submission, and even aging accounts receivable.
For chiropractors in these settings, boosting accuracy is often unrealistic unless there is a way to give the front office a way to work with patients currently at the clinic, as well as those calling with questions. Do you need to hire more employees? Not necessarily. Even so, it is unreasonable to expect one staff member to answer the phone, conduct intake interviews, verify insurance coverage, and reconcile insurance payments.
However, if you upgrade your communication setup to include artificial intelligence (AI) and automatic call routing, the same staff member can take the time needed to tick all these boxes.
How Communication Technology Frees up Staff Members
Missing calls are unacceptable. But telling a patient to wait while your receptionist picks up numerous calls is just as untenable. The trick here is to have a phone system that anticipates the need to take over receptionist duties and can do so immediately. Having it customized with smart call routing will get patients calling to the person they are looking for – even if it is only to voicemail. Your front desk worker continues to work with the patient currently in the office. It reduces errors caused by hurrying to meet everyone's needs.
Fax management is another critical element of effective communication. While fax seems to be taking a back seat to email, there are still providers who use HIPAA-compliant fax technology and have not yet transitioned to an email-only setup. Getting documentation sent to your office by a referring provider is now possible even while the front office staff is working with a patient already in the office. Additionally, it allows for effective communication with provider offices that may still rely on older technology.
Adding AI to Your Communication Capabilities Makes the System Even More Useful for Office Staff Members and Patients
Rather than taking the place of your front office staff, it supports them in their work. For example, AI functionality can serve as an answering service, assess the importance of a call, and interrupt staff members as needed in emergencies. Because AI technology is scalable, it can handle ever-increasing call volume without the need to hire more staff. Sometimes call volumes pick up after lunchtime, and your system can be configured to handle the influx.
Take a closer look at custom tailored healthcare practice communication solutions that could make a significant difference in your billing outcomes. (And your patients will not mind the speed with which they can reach the doctors or staff members they are looking for either.) Along with several billing software solutions, it could be just what you need to get your claims paid faster.
