Six Myths of Chiropractic Billing
Teresa Johnson • April 7, 2019
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!
“Caring for women’s health is a full-time responsibility - and so is making sure your practice gets paid for the care you deliver.” For many obstetrics and gynecology practices, the real challenge is not just clinical work but managing the financial side of the business. Billing for Ob/Gyn services is unique and complex because it often includes bundled maternity care, delivery charges, gynecological procedures, and preventive screenings. Without a streamlined billing solution, even a well-run practice can face delays in cash flow, high claim rejections, and frustrated staff. Why Ob/Gyn Billing Requires Special Attention? Ob/Gyn billing is unlike general medical billing. Obstetrics services often need global billing, meaning you bill for prenatal visits, delivery, and postpartum care as one package. Gynecology services may include preventive care, diagnostic procedures, and surgery, each with different payer requirements. The constant updates to payer rules and compliance regulations make it easy to miss crucial details that affect reimbursement. Common challenges include: Incorrect maternity bundling leading to underpayment. Missed modifiers for procedures performed on the same day. Improper documentation resulting in claim denials. Eligibility issues especially for prenatal patients with coverage changes mid-pregnancy. An efficient billing solution can address these pain points, freeing your team to focus on patient care instead of chasing payments. Benefits of Professional Ob/Gyn Billing Solutions Working with a dedicated billing partner brings clarity and consistency to your revenue cycle. Key benefits include: Accurate Charge Entry – Ensures all prenatal visits, ultrasounds, and procedures are captured. Clean Claims Submission – Minimizes denials by catching errors before submission. Compliance Assurance – Keeps your practice aligned with payer guidelines and HIPAA rules. Faster Payments – Streamlines claim follow-up so reimbursements arrive sooner. Improved Patient Experience – Clear statements and fewer billing errors reduce confusion. With these systems in place, practices can see improved revenue, fewer write-offs, and less staff burnout. Technology-Driven Billing for Ob/Gyn Practices Modern billing solutions use software and analytics to give you more visibility into your revenue. Dashboards can track claims at every stage, flag rejections instantly, and generate performance reports. Practices can quickly identify trends, such as high denial rates for certain procedures, and correct them before they impact future claims. Automation also reduces manual errors. For example, automated eligibility verification can confirm patient coverage before every visit, preventing delays later. The result is a smoother workflow for front-office staff and a more predictable revenue cycle for the practice. How Billing Buddies Supports Ob/Gyn Practices? Billing Buddies offers tailored billing services for obstetrics and gynecology providers. Their team understands the unique needs of women’s health practices and handles everything from charge entry to denial management. They work with your existing EMR and practice management system, eliminating the need for disruptive software changes. Their process typically includes: Comprehensive review of your current billing workflow. Identification of gaps leading to claim denials or revenue leakage. Implementation of best practices for accurate documentation and charge capture. Regular reporting so you know exactly where your revenue stands. This approach not only recovers lost revenue but also prevents future losses, ensuring your practice remains financially healthy. Compliance and Risk Management Ob/Gyn practices are closely monitored for compliance due to the nature of their services. Using a professional billing solution reduces your risk of audits by ensuring documentation supports all billed services. It also helps your practice stay compliant with changes to CPT codes, payer policies, and value-based care reporting requirements. Collaboration Between Clinical and Billing Teams One of the biggest strengths of a good billing solution is how it fosters collaboration. When providers and billers work together, documentation becomes clearer and claims are more likely to get paid on the first pass. Educating clinicians on documentation requirements, such as including gestational age or procedure specifics, helps eliminate guesswork for billers. Investing in Your Practice’s Financial Health Ultimately, choosing a strong billing solution is an investment in your practice’s stability. It allows your clinical team to spend more time with patients while reducing administrative burdens. A steady, predictable cash flow also opens opportunities to expand services, hire additional staff, and invest in better technology. Keeping Your Practice on Track Effective Ob/Gyn billing is not just about getting paid, it is about supporting the long-term growth and efficiency of your practice. With the right partner, you can reduce denials, improve compliance, and give your staff the freedom to focus on what matters most — your patients. Connect with Billing Buddies today and explore their full range of solutions, including chiropractic billing and claims management , to keep your practice financially strong and future-ready. Frequently Asked Questions (FAQs) Why is Ob/Gyn billing more complicated than other specialties? Ob/Gyn billing involves bundled maternity care, surgical procedures, preventive visits, and diagnostic services. Each type of service has its own coding and documentation rules, which makes the process more complex compared to other specialties. How can a billing partner help reduce claim denials? A billing partner uses claim scrubbing tools to catch errors before submission, verifies patient eligibility, applies correct modifiers, and follows up quickly on rejections. This reduces the likelihood of denials and ensures faster payment. What is global maternity billing? Global maternity billing combines all prenatal visits, delivery, and postpartum care into a single claim. It simplifies billing but requires accurate documentation to avoid underbilling or missing charges for additional services outside the global package. Do billing solutions work with any EMR system? Most professional billing companies, including Billing Buddies, can integrate with a wide range of EMR and practice management systems. This allows practices to keep their current setup while benefiting from expert billing services. How does outsourcing billing improve patient satisfaction? Outsourcing reduces billing errors, ensures clearer patient statements, and helps staff focus on delivering care rather than resolving payment issues. This leads to smoother interactions with patients and a more positive overall experience.
“A strong mind deserves a strong support system.” Mental health providers spend their time focusing on patient care, but behind every session lies an essential process - billing. Without efficient mental health medical billing services, practices face delayed payments, denied claims, and a lot of stress that distracts from patient care. This is where Billing Buddies steps in, helping providers streamline billing processes so they can focus on their patients. Mental health medical billing services are complex due to unique session structures, frequent policy changes, and payer requirements. Insurance companies require detailed documentation and compliance with specific rules. Even a small administrative mistake can delay reimbursement, which directly affects cash flow for clinics and private practices. Partnering with an experienced billing company not only simplifies the process but also ensures consistent revenue. Why is Mental Health Medical Billing Different? Billing for mental health services has its own set of challenges: Session-Based Billing : Many practices provide therapy sessions that vary in length, making accurate documentation and submission important. Frequent Denials : Claims can be denied for missing authorizations, incomplete patient details, or late filing. Telehealth Growth : Teletherapy has expanded rapidly, but insurers still have specific requirements for telehealth billing. Coordination of Benefits : Many patients have secondary insurance, which means claims must be filed in the correct order to receive full payment. This complexity means providers often spend hours on admin work, which reduces time spent with patients. Billing Buddies can help remove that burden. How Billing Buddies Supports Mental Health Providers? Billing Buddies specializes in mental health medical billing services, offering end-to-end solutions for practices of all sizes. Their team works to minimize claim denials while improving turnaround time for payments. Key benefits include: Accurate Claims Submission : Each claim is carefully reviewed before submission to reduce errors. Denial Management : If a claim is denied, the team quickly investigates and resubmits it, minimizing revenue loss. Compliance Assurance : The service stays updated with HIPAA regulations and payer policy changes. Revenue Cycle Transparency : Providers get regular reports on claims status, collections, and overall practice performance. With this approach, mental health providers can reduce administrative stress and improve financial stability. Tips for Maximizing Mental Health Billing Success While outsourcing to Billing Buddies can make billing easier, practices can also take steps to ensure smooth revenue cycles: Maintain clear, detailed patient records with treatment notes. Verify insurance coverage before each session. Stay informed about telehealth reimbursement policies. Follow up on unpaid claims promptly. Use a secure and reliable EHR system that integrates with billing processes. Combining these best practices with professional billing support creates a strong foundation for consistent revenue. Choosing the Right Partner Not every billing company understands the nuances of mental health billing. When selecting a service, look for a partner that: Has proven experience in behavioral health claims. Offers a transparent fee structure. Provides customized reporting. Is committed to compliance and data security. Helps practices grow with improved revenue management. Billing Buddies checks all these boxes and has helped mental health practices across Minnesota and beyond stay financially healthy while focusing on patient care. Keep Your Focus on Patient Care Your patients deserve your full attention, not a distracted mind worrying about unpaid claims. With Billing Buddies’ mental health medical billing services, you can simplify your revenue cycle and improve your cash flow. This allows you to focus entirely on helping patients while leaving the paperwork to experts. Contact Billing Buddies today and learn how their mental health billing solutions can support your practice. Explore their other services like doctor credentialing services to set your practice up for success. Frequently Asked Questions (FAQs) Why is mental health billing more complicated than general medical billing? Mental health billing often involves variable session lengths, special authorizations, and frequent policy updates. Insurers also have strict documentation requirements, which means providers must be very precise to avoid denials. How can outsourcing billing improve my practice’s revenue? Outsourcing reduces errors and ensures claims are submitted correctly the first time. This speeds up payments and decreases the number of denials, ultimately improving cash flow. Does Billing Buddies handle telehealth billing for therapy sessions? Yes. Their team stays updated on telehealth guidelines and ensures that claims for virtual visits are handled correctly so providers receive proper reimbursement. What happens if a claim gets denied? Billing Buddies investigates the denial, corrects any issues, and resubmits the claim promptly. Their denial management process helps prevent revenue loss and improves future claim acceptance. Is patient data secure when outsourcing billing? Absolutely. Billing Buddies follows HIPAA compliance and uses secure systems to protect patient data and maintain confidentiality.
"Efficiency is doing better than what is already being done." For healthcare providers, this means focusing on patient care while leaving complex administrative tasks to experts. One of the most critical but often overlooked aspects of running a successful medical practice is credentialing. Partnering with experienced healthcare credentialing companies can simplify this process, save time, and ensure compliance with ever-changing regulations. Understanding Healthcare Credentialing Healthcare credentialing is the process of verifying a medical provider’s qualifications, experience, and professional background. It ensures that doctors, nurses, and allied health professionals meet all necessary requirements to deliver safe and legal care. The process includes verifying education, licensure, work history, malpractice history, and professional references. Credentialing is essential for multiple reasons: It allows providers to participate in insurance networks. It protects patients by confirming provider competency. It reduces legal and financial risks for practices. It ensures compliance with state and federal regulations. Why Credentialing Can Be Challenging? Although crucial, credentialing can be a time-consuming and complex task. Many providers face these challenges: Time-Intensive Paperwork: Applications can involve dozens of forms and supporting documents. Frequent Updates: Licenses, certifications, and insurance contracts need periodic verification. Insurance Requirements: Different payers often have unique criteria, which must be strictly followed. Risk of Errors: Mistakes or incomplete submissions can lead to delays, denials, or even exclusion from insurance networks. For busy practices, managing credentialing internally can distract from patient care and hinder operational efficiency. How Healthcare Credentialing Companies Help? Partnering with healthcare credentialing companies like Billing Buddies allows practices to outsource this demanding task to professionals. These companies specialize in managing the entire credentialing process, ensuring accuracy and compliance. Key benefits include: Faster Enrollment: Credentialing companies streamline the submission and follow-up process with insurance payers. Error Reduction: Experienced staff ensure applications are complete and accurate, reducing delays. Regulatory Compliance: They stay updated on changing regulations, preventing compliance issues. Time Savings: Providers can dedicate more time to patient care and practice growth. Centralized Tracking: Credentialing companies maintain organized records for licenses, certifications, and renewals, making audits and updates easier. Choosing the Right Credentialing Partner Selecting the right healthcare credentialing company is crucial for smooth operations. Consider these factors: Experience: Look for companies with a proven track record in credentialing various specialties. Customization: The provider should tailor services to meet your specific needs, whether you are a single practitioner or a large multi-provider practice. Technology: Efficient use of credentialing software can speed up the process and provide real-time updates. Transparency: Choose companies that offer clear communication, regular reporting, and easy access to records. Comprehensive Services: Some companies also handle payer enrollment, re-credentialing, and provider contracting, offering a one-stop solution. How Credentialing Impacts Revenue? Efficient credentialing directly influences a practice’s revenue cycle. Providers who are not properly credentialed may face claim denials or delayed reimbursements. Credentialing companies help prevent revenue loss by ensuring that providers are recognized by insurance networks, allowing timely billing and payments. Moreover, credentialing firms often collaborate with billing experts to integrate credentialing and billing processes. This ensures that every service provided is properly documented, coded, and submitted for reimbursement. For instance, integrating credentialing with physical therapy billing services can reduce delays and streamline claims management for therapy practices. Beyond Credentialing: Operational Support Many healthcare credentialing companies also provide additional operational support, including: Provider onboarding and contract negotiations Compliance audits and risk management Staff training on documentation and billing procedures Periodic updates on regulatory changes This holistic approach not only maintains compliance but also enhances overall practice efficiency and profitability. Common Credentialing Mistakes to Avoid Even with professional support, it is helpful to understand common pitfalls in credentialing: Submitting incomplete applications Missing deadlines for license renewals Ignoring payer-specific requirements Failing to keep detailed records of credentials and communications Assuming credentialing is a one-time task instead of an ongoing process By partnering with experts, practices can prevent these mistakes and maintain uninterrupted operations. Optimize Your Practice with Expert Credentialing and Billing Solutions Healthcare credentialing is an essential but complex process that directly impacts compliance, patient safety, and revenue. Outsourcing this function to professional healthcare credentialing companies like Billing Buddies ensures accuracy, speed, and efficiency. Practices can focus on what matters most: delivering excellent patient care, while credentialing experts handle the administrative and regulatory demands. For healthcare providers looking to optimize revenue and maintain smooth operations, integrating credentialing with expert billing solutions such as physical therapy billing services can create a seamless, efficient workflow. So, maximize your practice’s efficiency, reduce administrative stress, and ensure compliance by partnering with a trusted credentialing company. Contact Billing Buddies to learn how their credentialing and billing solutions can streamline your healthcare practice. Frequently Asked Questions (FAQs) What is the difference between credentialing and licensing? Licensing is the state-granted permission to practice medicine legally, while credentialing verifies a provider’s qualifications and professional background for insurance networks. Credentialing ensures a provider meets payer standards and maintains compliance. How long does the credentialing process take? The credentialing process typically takes 60 to 120 days, depending on the provider’s specialty, payer requirements, and completeness of documentation. Professional credentialing companies can help reduce this time significantly. Do credentialing companies handle re-credentialing? Yes. Most credentialing firms manage both initial credentialing and ongoing re-credentialing to ensure providers remain compliant with insurance and regulatory requirements. Can credentialing errors affect my practice’s revenue? Absolutely. Errors or delays in credentialing can lead to claim denials, delayed reimbursements, or exclusion from payer networks, impacting the practice’s revenue and cash flow. Is outsourcing credentialing cost-effective? Yes. While there is a fee for credentialing services, outsourcing reduces staff workload, prevents costly errors, and ensures faster reimbursements, often resulting in overall savings. What is the first step to get started with a credentialing company? The first step is a consultation to assess your practice’s needs, gather required documents, and outline a credentialing plan tailored to your providers and specialties.