Thearticle, written by Rebecca Jones talks about the problems that manychiropractic doctors encounter when submitting a claim form to aninsurer which is error-free and denial proof. While statistics forthe number of claims that are denied in a year by insurers due tobilling errors or wrong coding are unavailable, an insuranceadministration in the state of Maryland approximates it at 14.9% inthe year 2009. On the other hand, that of “clean claims” thatwere denied are less than 1%.
Otherthan the fact that chiropractic offices cannot employ medical codingexperts to do their billing like large medical practices, they alsosuffer from having bad information. For instance, many DCs have beenmade to believe that signing the Advance Beneficiary Notice once fora patient is enough to cover for all visits, but in reality, it isnot.
Theshocking part is that this bad information is obtained from somecoding and billing classes. Other common mistakes or errors that areusually done are such as inserting spaces in the ID number, wrongprovision of the National Provider Identifier Number, combining morethan one diagnosis in the pointer box, filling the wrong date, usageof modifiers incorrectly and failure to notice something primary toMedicare.
Sometimesclaims also end up getting lost therefore leading to claims notgetting paid. Claims can fail to either get to the clearing house orbe transmitted to the insurance carrier or get processed by theinsurer after they have been received. All these situations aretermed as lost claims.
AffordableCare Act comes to the rescue by providing a manual, The ACA Manualthat contains all codes and staff billing that one needs tounderstand. The manual also explains what to fill in every box in theMedicare section. Despite doctors` good faith in filing a cleanclaim, it will still be denied, and they need to contact the insurersto solve the issue and if it fails they should then talk to thepatient.
Jones,R. (2017). .Retrieved 23 March 2017, fromhttps://oldsite.acatoday.org/content_css.cfm?CID=4920