Six Myths of Chiropractic Billing

Welcome to Billing Buddies YouTube and Podcast series. 

In this episode, we will be discussing six myths of chiropractic billing. Billing Buddies has been doing chiropractic billing for 25 years and over the years have experienced doctor offices having misinformation.   We will share six areas that are commonly misunderstood.

Myth # 1:  Chiropractors need X-rays on all Medicare patients. 

Answer:  On January 1, 2000, Medicare gave the option to doctors to take X-Rays or do a PART exam to demonstrate subluxation of the spine.  Review your Medicare LCD (Local Coverage Determination) to see how to properly document a PART exam.  The LCD’s can be found at your local carrier’s website or there’s a link at www.cms.gov.

Myth # 2:  Chiropractors need an ABN on all Medicare patients. 

Answer:  ABN’s (Advanced Beneficiary Notice) are only required on covered Medicare services that don’t meet Medicare coverage guidelines.  ABN’s should be given on a case by case basis.  For example:  if you are providing a 98940, 98941 or 98942 service and the patient is on maintenance care, an ABN should be presented to the patient.

Myth # 3:  Chiropractors can’t charge an exam fee for Medicare patients.  

Answer:  Charging practices need to be uniform for all patients.  Practices need to charge Medicare patients for exams even if they are not covered by Medicare.   By failing to charge Medicare patients, practices are profiling patient segments and charging differently which is prohibited by CMS.

Myth # 4:  Chiropractors can opt out of Medicare and charge Medicare patients directly. 

Answer:  Chiropractors cannot opt out of Medicare.  If a chiropractor does not have a PAR or a Non-PAR Medicare contract, he cannot treat a Medicare patient.  The patient needs to be referred to a chiropractor that has a Medicare contract.

Myth # 5:  Chiropractors can’t charge for therapy services.

Answer:  Charging practices need to be uniform for all patients.  If provided, chiropractors need to charge Medicare patients for therapies even if Medicare does not cover them.

Myth # 6:  Chiropractors (or any healthcare professional) can write-off hardship balances for low income patients.

Answer:  Healthcare providers may write-off balances for hardship if they have a hardship policy and verify income.  Healthcare providers must have a hardship policy, verify income and follow uniform hardship guidelines for all patients.

These are the six chiropractic billing myths.  This presentation was brought to you by Billing Buddies.  Billing Buddies is a medical billing and consulting service established in 1994.  We offer services to a variety of specialties across the United States.  For more information, please call or text 612.432.2366.  Thank you for listening to Billing Buddies YouTube and Podcast Series and remember to “Buddy Up with the Best”, Billing Buddies.   Have a great day!