There are almost as many different types of insurance as there are patients. It is important to become familiar with the more common types of plans you may encounter in your office. View the Rapid Tutorial below titled Understand Various Insurance Plans. This overview will serve as foundational knowledge every DC and CA should master when…
Certified Chiropractic Clinical Assistant Training is now available as part of Library Membership! This official training is for those who wish to certify through the Federation of Chiropractic Licensing Boards (FCLB). The KMC University Library is an online resource for chiropractors and their teams that provides access to a vast array of educational materials and resources related to Medicare, documentation, billing, coding, compliance, and the business aspects of running a chiropractic practice. It can help chiropractors and their teams stay up-to-date on the latest regulations and best practices, as well as save time and money by avoiding costly mistakes.
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Commercial health insurance, also known as personal health benefits and major medical insurance benefits, plays a key and active role in many chiropractic offices. A robust understanding of how insurance works is essential to establish confident and well-prepared team members. Your knowledge concerning the ins and outs of personal health insurance benefits is crucial to…
Certified Chiropractic Clinical Assistant Training is now available as part of Library Membership! This official training is for those who wish to certify through the Federation of Chiropractic Licensing Boards (FCLB). The KMC University Library is an online resource for chiropractors and their teams that provides access to a vast array of educational materials and resources related to Medicare, documentation, billing, coding, compliance, and the business aspects of running a chiropractic practice. It can help chiropractors and their teams stay up-to-date on the latest regulations and best practices, as well as save time and money by avoiding costly mistakes.
Click here to learn more.
The Reimbursement Path
Clinics must complete the verification process, consult the payer’s Medical Review Policy, and confirm the clinical need for orthotics. Then, it is time to decide which reimbursement path the clinic will pursue – self-pay or third-party pay. Keep in mind all required components of the No Surprises Act and any other federal guidelines when establishing both processes. Listed below is a brief list of considerations for each reimbursement path.
| Insurance Reimbursement |
Patient Self-Pay |
| The patient’s medical record demonstrates the payer’s documentation requirements for prescribing functional orthotics. |
The patient’s medical record documentation meets minimum state regulations and/or board documentation requirements. |
| Documentation includes essential information to support the allowed conditions for which functional orthotics may be prescribed, per the payer’s Medical Review Policy (MRP). |
The practice must offer a Good Faith Estimate (GFE) to include functional orthotics costs if the patient is not utilizing insurance for any service rendered in the clinic or is uninsured. |
| ICD-10 diagnosis codes must match the allowed conditions to the highest level of specificity and point to the functional orthotics CPT (Current Procedural Terminology) ® codes. |
When the payers’ definitions of coverage do not include the patient’s condition/diagnosis, the practice must obtain an Advance Notice to Member for Non-covered Services on the payers’ form or their own. |
| Verify that the allowed fee for the functional orthotics exceeds the doctor’s cost. If not, initiate the option to use S1001 code for luxury items, if allowed, with notice to the patient. |
When the practice fee schedule for functional orthotics is too steep for self-pay patients, consider membership in ChiroHealthUSA, a Discount Medical Plan Organization (DMPO) network for legal discounts. |
| Code ancillary services, like orthotics management and training, when appropriate, to describe additional work by the provider that is associated with the prescription of the functional orthotics, and expect payment from the third-party payer. |
Consider allowing the patient to pay for the functional orthotics and associated services over time. Implement a payment plan that works for the practice and the patient’s budget. |
Download Support Tool There are a variety of patient types and each of them must be considered when making a business decision with regards to the practice’s financial set up. If you decide to accept all patient types, you need to count the cost. This can only be done by properly evaluating what is involved…
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