Around this time every year, Holistic Billing gets swamped with calls from newly minted healthcare providers. On these calls, an all-too-frequent question is “what is necessary for accepting insurance?”. Here’s the quick answer, whether fresh-out-of-school or looking to add insurance to an existing practice, the first thing you need to do to participate with insurers is applying for your NPI.
As a billing company focused on holistic healthcare providers, we‘ve introduced our share of acupuncturists to the world of acupuncture insurance billing codes. On any given year, roughly half of our new clients will have never billed insurance before they started with Holistic Billing Services, so we are quite accustomed to their most frequently asked questions.
Quite often we notice trends affecting acupuncture practitioners quite literally before anyone else. Therefore, we strive to let you know what is happening with acupuncture billing codes before it costs your practice money. In the past few weeks, our account managers have reported higher than usual calls from practitioners seeking advice on how to handle medical record audits from insurance carriers.
When participating with insurance carriers we are all subject to audits, and they can be very difficult and stressful, so, what do you do if you get an audit request from an insurer? First, it is helpful to understand auditors. Essentially, they are looking for medical records lacking sufficient documentation. Usually, this includes over-coding, misuse of procedure codes and billing for improper evaluation and management code levels. Specific to the frequently used acupuncture billing codes, auditors often find fault in the lack of documentation for the time of treatment.
When you are reviewing your medical notes ask yourself:
- Are there examination notes for each visit?
- Do the chart notes support the diagnosis and procedures you billed?
- Do your notes clearly document the time of treatment?
- Are the medical records signed and dated?
As a rule of thumb, you are doing yourself a disservice by sending partial records when you have material in your chart that may substantiate care rendered and services billed. The flip side is that unrequired information will likely hurt your case rather than help it so only provide information that is mandated by contract, government payor, court-ordered, etc. You are not required to give the auditor the original medical record. So, make copies and keep an accurate accounting of all the medical records requested and handed over to the auditor.
If you are chosen for an audit, we are here to help. We have medical coding, financial and legal experts to assess how your records hold up upon review.
As a consulting company focused on integrative medicine, we’ve helped thousands of practitioners and owners expand their practices by adding insurance billing for massage therapy. On any given year, half of our new clients have never billed insurance before they start using our services, so we are familiar with the most frequently asked questions when it comes to billing insurance for massage. Here are just a few:
- Can a licensed massage therapist bill insurance?
- What insurance companies pay for massage therapy?
- What are the insurance billing codes for massage therapy?
Can a Licensed Massage Therapist Bill Insurance?
The Veterans Choice program through the Department of Veterans Affairs (VA) enables you to care for veterans. Whenever a vet lives too far from a VA facility or the VA is unable to treat the vet within the next 30 days the patient is referred to community-based providers.
If you are interested in treating military veterans, you will need to enroll in the Veterans Choice Program (VCP) with one of the VA’s 3rd party administrators, Health Net, or TriWest. Dealing with the VA has its challenges, but over the last couple of years on-average the VCP has been a great program for our customers billing insurance for acupuncture.
Provider Enrollment Page: https://www.healthnetpc3provider.com/p3c/?register=true
Provider Enrollment Page: https://www.joinournetwork.triwest.com/Forms/AddProvider.aspx
Once your Veteran’s Choice Program registry submission is validated, you will receive an email confirming receipt of your submission and approval status. Then you will appear in their directory for veterans to search. Eligible veterans can then contact Health Net or TriWest to obtain authorization prior to your care. Once the vet contacts your practice, they will provide a pre-authorization letter that you will need to submit along with your initial insurance claims for the patient.
Are you interested in learning more about acupuncture billing from an acupuncture billing company? Here are some additional tips!
So you have finally made the leap and decided to accept insurance for your services, congratulations! As a billing company focused on holistic medicine we speak to hundreds of new practitioners every day so we have a good sense of what the hot button items are within our community. Whether you are looking for chiropractic insurance billing codes or acupuncture diagnosis codes, we hear it all! A frequently asked question from providers considering accepting insurance is should you bill under the practice name or social security number.The decision to bill under your practice name or social security number should be addressed prior to treating patients, ideally, after consulting with an accountant or attorney as to which makes the best sense for you.
To start billing to an insurance company you will typically need a state license and a National Provider Identifier (NPI). The NPI is used by insurance companies as your unique identifier when you submit acupuncture, chiropractic or massage billing codes. If you have EIN number or Tax ID associated with your practice you will need both an NPI for the organization as well as NPI for each individual provider performing services.
If you don’t have an NPI number you can apply for one here: https://nppes.cmsA.hhs.gov/#/.
If you have an NPI (but can’t seem to remember where you placed it), try looking it up in the registry http://www.npinumberlookup.org/.
Are you interested in learning more about acupuncture billing?
Here are some additional tips!
Your patients are your business. But it‘s not how many patients your acupuncture practice schedules that matters, rather it‘s the profit that those patients generate that will be the difference between a successful practice and one that is closing its doors. So, to set an advertising budget, you need to understand the value of your patients and to do that you need to understand your Customer Lifetime Value (CLV).
As an acupuncture billing service we transmit thousands of insurance claims to Aetna on any given week. This year, Aetna is in the process of changing its provider policy to send only electronic payments. This will affect all practitioners who receive paper check payments. So, you must enroll in an electronic payment option by May 1, 2017.
As a billing company focused on holistic medicine we speak to hundreds of practitioners on a daily basis so we get a pretty good sense on what the hot button items are within our community. At the beginning of every year most patient‘s health insurance benefits are recalculated. That is to say that the number of visits and deductible amounts are re-set on January 1. So a frequently asked question through our provider hotline is “How do I handle a patient‘s deductible?”
With the dust settling on the most contentious election in recent memory it‘s time to sort out what the new political landscape will mean for healthcare, namely how will the Affordable Care Act (ACA) be affected.