Coding, Billing, Documentation and Credentialing
Chiropractic Legal Solutions offers our Clients “in-depth”, readily understandable, instruction and advice on the choice of proper procedure codes, their interrelationship with required documentation, the relationship between proper coding and state insurance laws, compliance issues involved in proper application of credentialing protocols and overall compliance issues related to the operation of a chiropractic practice’s “front” and “back” office procedures. All of our services are designed to assure application of appropriate billing protocols that will maximize collection of patient accounts.
Specific areas of consultation in business procedures include:
- Instruction on understanding proper choice and use of CPT and ICD-9 coding, billing, medical documentation, insurance procedures and maintenance of patient records that will enable your front office to run smoothly and efficiently.
- Instruction and assistance in determining whether you need to operate as a an individual or group practice, what the difference is, why it is important to know and what to do to get it right!
- Instruction on the difference between in network and out of network status, how to operate within and outside of managed care networks, as well as insurance network contracting issues and processes.
- Understandable instruction on how examination codes, procedure codes and diagnosis codes interact together with claim submission, how to determine the appropriate exam, procedure and diagnosis code(s) to use and the appropriate and necessary level of medical documentation required to accompany each code.
- Explanation and detailed instruction on specific medical documentation requirements for individual codes.
- Instruction on the dos and don’ts practitioners need to know with respect to co-payments, deductibles, co-insurance, time of service discounts and dual fee schedules.
- Instruction on how to submit clean claims to avoid rejections, denials and reimbursement delays, how to address retrospective insurance audit reviews and patient record audits, how to perform re-billing procedures and the importance knowing when to do same.
- Explanation of the options available to the practitioner regarding in-house vs. outsourced billing and software options. Assistance in evaluating and selecting the most appropriate billing software for the individual practitioner’s specific needs [note, there are a lot of software programs available, but only a few offer the versatility necessary for the successful operation of a chiropractic practice].
- Explanation and instruction on what constitutes a complete patient chart and the type of appropriate documentation, including treatment plans, required for the services provided.
- Review of your appropriate state regulatory guidelines affecting documentation of patient services.
- Explanation and instruction on the documentation requirements for commercial, worker’s compensation, personal injury and Medicare carriers.
- Explanation and instruction on how to overcome the fear of asking your patients for payment.
- Explanation of how to generate revenue ethically while putting your patients care first and how to create effective “Maintenance Programs” for your patients, and
- Explanation, instruction and assistance in applying for credentialing status with managed care companies and how credentialing interacts with other aspects of the operation of your chiropractic practice, including the dangers inherent in practicing with credentialed status.