Reasons for Denied Chiropractic Claims

September 8, 2018Chiropractic Care

Denied Chiropractic Claims

Receiving chiropractic denied claims can be frightening, and appealing them can seem overwhelming, but it’s important to take the time to do it. No clinic can stay afloat if too many claims are denied. It can be downright frustrating to file claims only to see them denied later.  It is necessary to understand the reason why claims are getting denied by payers. Only then it will be easy for you to prevent any financial free-fall.

Reasons for Denied Chiropractic Claims

Administrative Denials

Administrative denials occur when there are mistakes in the paperwork such as an incorrect ID number on the claim or a technical error. You will receive this denial simply because you have not updated patient information or filled wrong information while claim submission. When you are working on administrative denials you are just re-processing the claim.

Insufficient Documentation for Chiropractic Claims

If your claim has the wrong supporting documentation, your payment could be delayed or completely rejected. Insurance companies have very specific rules for coverage, of course, and claims must establish the necessity of patient care, the fact that it was provided to the patient, and any outcomes and follow up that are expected according to standards of care for your profession, local area, and the insurer. Keeping documentation complete helps prevent problems with payment and also keeps inconsistencies at bay, allowing you to successfully keep your claims paid and efficiently processed.

Medical Necessity/Pre-Authorization

Clinical denials occur when insurance companies question the medical necessity of a procedure or treatment or label the procedure as investigational or experimental. Another major reason for clinical denial is the absence of prior authorization. If you’ve already sent in a claim, you can’t go back and submit an authorization.

Incorrect Payment

If you are billing for the wrong amount, the insurance company may just reject the payment or delay it altogether. To prevent this from happening, you may need to review your billing process or enlist the help of a clearinghouse to check your claims and process them.

Coding Errors

Coding errors are a reality of the billing process, particularly if you are using paper billing, relying on templates, and not checking your work before sending them off. This is where outsourcing your billing to an experienced service or using a clearinghouse can help. Electronic billing is frequently standard now, but many practices still rely on older methods (i.e., paper) that can hold them back.

Patient’s Plan Coverage

Verifying your patient’s insurance before providing care can help minimize this problem. It is best to have all insurance issues sorted before bringing on new patients, and regularly check eligibility for existing patients. It is a good habit to check patient insurance coverage for changes once a year. Your patient may not actually have current insurance coverage even if they think they do. Their plan may not cover chiropractic care, or they may be wrong about how many visits or the types of visits that are actually covered.

Since a significant number of claims get denied by payers, it has become necessary for practices to streamline their billing processes and hire experienced staff.  Many chiropractors are choosing to outsource their billing functions. To know more about Chiropractic Medical Billing Services provided by E2E Medical Billing Services you can call us at 888-552-1290 or write to us at info@e2eMedicalBilling.com

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