For many integrative healthcare practitioners, navigating the complexities of insurance billing can be a significant challenge. However, understanding how to master insurance billing is crucial to your practice’s financial success and growth. This blog post will discuss essential tips and strategies to help acupuncturists, licensed massage therapists, and chiropractors overcome common insurance billing obstacles and streamline their revenue cycle management.
Understand the Basics of Insurance Billing
The first step in mastering insurance billing is familiarizing with the basic concepts and terminology. Key terms to understand include:
- CPT Codes: Current Procedural Terminology codes describe medical procedures and services healthcare providers perform.
- ICD-10 Codes: International Classification of Diseases codes are used to classify and code diagnoses.
- Provider Network: The group of healthcare providers contracted or participating with an insurance company to provide services to their members.
- Reimbursement: The payment received by a healthcare provider from an insurance company for services rendered.
- Explanation of Benefits (EOB): A document sent by the insurance company to the patient and provider detailing the services provided, the amount billed, and the amount paid by the insurance company.
Verify Patient Insurance Eligibility
Before providing services, verifying each patient’s insurance eligibility and benefits is essential. This includes checking for coverage details such as deductibles, copayments, and any limitations or exclusions. Verifying eligibility upfront helps prevent denied claims and ensures that you have accurate information about the patient’s insurance benefits.
Keep Accurate and Detailed Documentation
Proper documentation is crucial to the insurance billing process. Ensure that your patient records are thorough, accurate, and up-to-date, including the patient’s demographic information, insurance details, and relevant medical history. Document the services provided using the appropriate CPT and ICD-10 codes for each visit. Accurate documentation helps prevent claim denials and protects your practice during audits or disputes.
Stay Up-to-Date with Billing Regulations and Payer Requirements
Insurance billing regulations and payer requirements are constantly evolving. To ensure that your practice remains compliant, stay informed about changes in billing rules, coding updates, and any changes to payer-specific guidelines. Resources such as industry newsletters, webinars, and professional associations can help you stay informed and up-to-date.
Invest in Practice Management Software and Billing Services
Investing in practice management software, like Holbie, can help streamline your revenue cycle management and master insurance billing by automating tasks such as patient registration, appointment scheduling, and claims submission. Holbie also offers a comprehensive insurance billing service, which can save you time and resources by handling the entire billing process on your behalf, from claim submission to payment follow-up.
Monitor and Track Your Billing Performance
Regularly monitoring and tracking your billing performance is crucial to identifying areas for improvement and ensuring the financial health of your practice. Review key performance indicators (KPIs) such as claim denial rates, days in accounts receivable, and the percentage of revenue collected. By analyzing your billing data and identifying trends, you can make informed decisions about your practice’s billing processes and revenue cycle management.
Mastering insurance billing is essential for the success of your integrative healthcare practice. By understanding the basics, verifying patient eligibility, maintaining accurate documentation, staying informed about regulations, investing in practice management software or billing services, and monitoring your billing performance, you can streamline your revenue cycle management and focus on providing exceptional patient care.
How does this apply to a billing business that specializes in medical-massage, acupuncture, and chiropractic billing? You do not need to spend all your time on the time-consuming and challenging medical coding and billing procedure while you are occupied filling your schedule. Your time, energy, and creativity are freed up to concentrate on what matters most: your patients by having a reputable company like Holistic Billing Services handle your online appointments, SOAP notes, or your medical billing burden. The welcoming professionals at HBS have years of experience and are glad to support you in EHR and medical billing success! Get in touch with us to create a unique solution that meets the demands and objectives of your practice.
We have offered holistic providers complete medical billing and coding services since 1999, so we understand what makes medical billing and coding successful. In this article, we share our knowledge to assist you in selecting the best service for your medical practice.
Medical coding and billing are crucial components of any healthcare operation. It guarantees rapid and accurate claim processing, which results in quick reimbursements and improved revenue cycle management. The effectiveness and profitability of your clinic can be considerably impacted by your choice of medical billing and coding company, which can be challenging. This article will review the essential medical billing and coding service elements. In addition, we’ll also share tips on how to find the best fit for you.
Knowledge and Skills
Experience and industry knowledge are the most critical factors when selecting a medical billing and coding service. Please search for a business with a successful track record and extensive expertise working with medical practices like yours; this helps to ensure that they know the particular difficulties faced by your practice and have the knowledge and tools necessary to address them.
Security and Compliance
The field of medical coding and Billing is very regulated. Selecting a service that prioritizes adherence to pertinent healthcare laws, including the Health Insurance Portability and Accountability Act (HIPAA), is crucial. Be sure the business you choose maintains stringent security measures to guard sensitive patient data from data breaches and illegal access.
Flexibility and Personalization
Your billing and coding provider should be able to adjust to your particular demands because every medical practice is different. To create a customized solution for your practice’s billing and coding needs, look for a provider that offers customizable solutions and will collaborate closely with your staff.
Automation
A professional medical billing and coding service should use the most up-to-date technology to optimize revenue collection, speed up the billing process, and decrease errors. Faster claim processing and more precise reimbursements will result from this. To increase productivity and reduce manual input, look for a company that uses software and automation whenever possible.
Pricing and Contract Terms
Considering the price and contract details when assessing billing and coding services is critical. In addition to their fees, which are typically based on a percentage of collections, you should carefully read the contract terms to comprehend the range of services offered, the method of payment, and any potential penalties or termination clauses. Seek transparent pricing models with no hidden costs that fit your practice’s budget.
Customer Support and Responsiveness
When it comes to billing and coding, excellent customer support is essential. You want a business that will address your needs and problems. To receive individualized support and guidance through the billing process, look for a service that provides dedicated account management or a point of contact.
Testimonials
One of the best methods to evaluate a medical billing and coding service’s success is to look at client references. Choose a business with a good reputation. As the saying goes, past performance is the best indicator of future performance. A more excellent grasp of their track record and assistance in making an informed choice will come from their business references.
Ongoing Support
A good medical billing and coding firm should also offer continuing training and assistance to your employees, so they stay informed about changes in the field and best practices. Regular updates on coding standards, educational webinars, or specialized training events fall within this category.
Six Pointers to Help You Choose the Best Medical Coding and Billing Company
Here are some suggestions to help you choose the best medical billing and coding service for your clinic now that you are aware of the elements to take into account:
Research
Start by researching the many medical billing and coding services that are offered. Search for suppliers with expertise dealing with comparable businesses or specializing in your specialty. Compile a shortlist of prospects based on their qualifications, knowledge, and client testimonials.
Compare
Request proposals from the vendors you are considering. Use the proposals to compare each company’s services and reduce your candidates. Information about their services, price, technological solutions, and compliance procedures should all be included in a thorough presentation.
Schedule
Make appointments to speak with the leading candidates on your list before deciding. Ask them about their background, offerings, and how they may assist your practice in streamlining its billing and coding procedures during these encounters. Please take advantage of the chance to evaluate their receptivity, communication abilities, and willingness to adapt their services to your demands.
Check
Make an effort to reach out to the clients listed on the references provided by each prospective organization. You’ll be able to learn directly about their effectiveness, customer service, and general experience.
Evaluate
Understanding the vendor’s onboarding procedure is crucial because switching to a new medical billing and coding service can be difficult. Analyze their capacity to work with your current systems, impart knowledge to your personnel, and offer continuing assistance during the transition.
Consider
It’s crucial to consider a medical billing and coding service’s long-term profitability while making your choice; this entails assessing its financial standing, room for expansion, and resolve to keep up with market developments. A strong and progressive organization will likely support the long-term success of your practice.
Conclusion
Your choice of medical billing and coding provider can dramatically impact the effectiveness and profitability of your practice. You may find a provider who meets your needs and aids in the optimization of your revenue cycle management by considering variables like experience, compliance, technology, and cost. Take your time with the decision-making process; instead, consider each prospective provider before selecting the best fit for your practice’s particular needs.
How does this relate to an EHR and insurance billing company focused on acupuncture, chiropractic, and medical-massage billing? While you are busy vetting other vendors, your time can be free of tedious technology or complicated medical coding and billing process. By letting the best firm focused on integrative healthcare Holistic Billing Services handle your online appointments, SOAP notes, or medical billing needs, your energy, creativity, and talents are freed up to focus on identifying and serving your patients. The friendly experts at Holistic Billing have over 20 years of experience and are eager to help you succeed in EHR and Medical Billing! Contact us today to get started building a solution that suits your acupuncture practice needs and goals.
When owning a holistic practice, one of the most important things to consider is how to handle insurance billing; this can be tricky and time-consuming, but ensuring that your patients receive the reimbursement they are entitled to is essential. As a holistic practitioner, choosing an insurance biller who understands the unique needs of your practice, whether it be acupuncture, chiropractic, or medical massage, can help you navigate the complex world of insurance billing. This blog post will discuss critical factors on how to pick an insurance biller for your holistic practice covering acupuncture, chiropractic, or a medical massage practice.
Experience and Expertise
One of the most important things to consider when choosing an insurance biller is their experience and expertise in your field. Each type of holistic practice has its unique billing requirements and codes, so it is essential to choose an insurance biller who is familiar with the ins and outs of your field. For example, suppose you run an acupuncture practice. In that case, you will want to choose an insurance biller who has experience with acupuncture insurance billing and is familiar with the codes and procedures specific to this field. The same goes for chiropractic and medical massage practices.
Credentials and Accreditation
Another critical factor to consider when choosing an insurance biller is their credentials and accreditation. Selecting an insurance biller certified in medical coding and accredited by professional organizations in your field is essential; this will ensure they have the necessary knowledge and training to handle your insurance billing needs. Additionally, it is a good idea to choose an insurance biller who is a member of professional organizations such as the American Medical Billing Association (AMBA), the National Association of Medical Billers and Coders (NAMBC), or the Healthcare Business Management Association (HBMA)
Communication and Responsiveness
When it comes to insurance billing, communication, and responsiveness are key. You would like to choose an insurance biller who is easy to communicate with and responsive to your needs. It is crucial to have a clear and open line of communication with your insurance biller so that you can address any issues or questions that may arise. Additionally, you want to choose an insurance biller who is responsive to your needs and can help you navigate any challenges that may come up.
Services Offered
When choosing an insurance biller, it is essential to consider their services. You want to select an insurance biller who can handle all aspects of your billing needs, including credentialing, insurance benefit verifications, submitting claims, following up on denied claims and managing patient accounts. Also, you’d like to choose an insurance biller who can help you with coding and compliance issues and give you regular reports on your billing status.
Cost
Lastly, it is vital to consider the cost of the insurance biller’s services. While cost should not be the only factor in your decision-making process, choosing an insurance biller who offers competitive rates is essential. Also, you’d like to select an insurance biller who is open about their fees and can give you a detailed breakdown of their costs. It is essential to choose an insurance biller who has experience and expertise in your field, is certified and accredited, has good communication and responsiveness, and offers a range of services at a competitive cost. By considering these factors, you can ensure that your insurance billing needs are met and that you receive the reimbursements generated by your work.
How does this relate to a billing company focused on acupuncture, chiropractic, and medical-massage billing? While you are busy filling your schedule, your time does not need to be consumed by the tedious and complicated medical coding and billing process. By letting a trusted firm like Holistic Billing Services handle your online appointments, SOAP notes, or your medical billing burden, your time, energy, and creativity are freed up to focus on what matters most: your patients. The friendly experts at HBS have decades of experience and are eager to help you succeed in EHR and medical billing! Contact us today to get started building a custom solution that suits your acupuncture practice needs and goals.
Acupuncture is a rapidly growing alternative and integrative therapy that offers a range of benefits for pain management and other health conditions. However, starting and running a successful acupuncture practice requires a well-thought-out marketing plan to attract and retain clients. A marketing plan helps you define your target audience, understand your competition, and develop a strategy to reach your goals. This blog post will provide tips for how to develop a marketing plan for your acupuncture practice and list five top resources for small business owners.
Step 1: Define Your Target Audience
The first step in developing a marketing plan is to define your target audience; this includes identifying the demographics of your ideal patient, such as age, gender, income, and location. Additionally, consider the health conditions and symptoms for which your ideal patient may seek treatment, such as pain management, fertility, or sleep disorders. Understanding your target audience will help you down the line to tailor your marketing messages and strategies to reach and engage with them effectively.
Step 2: Conduct a Competitive Analysis
Next, conduct a competitive analysis to understand your competition and identify potential gaps in the market. Research other acupuncture practices in your area and evaluate their marketing strategies, services offered, and the type of patients they target. This information can help you identify opportunities to differentiate your practice and position yourself as a leader in the market.
Step 3: Set Marketing Goals and Objectives
Once you have defined your target audience and conducted a competitive analysis, it’s time to set marketing goals and objectives. These goals should align with your overall business strategy and be specific, measurable, attainable, relevant, and time bound. For example, a plan for your acupuncture practice may be to increase new patient visits by 20% in the next six months.
Step 4: Develop Your Marketing Strategy
With your target audience, competitive analysis, and goals in mind, it’s time to develop your marketing strategy; this includes identifying the tactics and channels you will use to reach your target audience and achieve your marketing goals. Some common marketing tactics for acupuncture practices include:
- Website and SEO: Your website is often the first impression a potential patient will have of your practice. Make sure it is professional, easy to navigate, and provides all the information your target audience needs. Additionally, optimize your website for search engines to improve visibility and attract new patients.
- Online Advertising: Online advertising, such as Google Ads or Facebook Ads, can effectively reach your target audience and drive traffic to your website.
- Content Marketing: Content marketing involves creating valuable, relevant, and consistent content to engage with your target audience and build trust and authority. Consider writing blog posts, making videos, or hosting events to educate your target audience about the benefits of acupuncture.
- Referral Marketing: Referral marketing encourages existing patients to refer friends and family to your practice. Offer incentives, such as discounts or free treatments, to encourage patients to guide others.
- Social Media Marketing: Social media marketing means using social media platforms like Instagram, Twitter, TikTok and Facebook to promote your practice and sell your products and services.
Step 5: Monitor and Evaluate Your Results
Finally, monitor and evaluate your results to see what is working and what is not. Regularly track your marketing metrics, such as website traffic, patient visits, and conversions, and adjust your strategy as needed. This ongoing evaluation will help you improve your marketing efforts and achieve your marketing goals.
Resources when establishing your marketing plan.
- Small Business Administration (SBA): The SBA provides a wide range of resources and support for small businesses, including loans, grants, counseling services, and training.
- SCORE: SCORE is a national organization that provides free mentoring and resources to small business owners.
- National Small Business Association (NSBA): The NSBA is a nonprofit organization that provides advocacy, networking, and resources for small business owners.
- National Center for Complementary and Integrative Health (NCCIH): The NCCIH provides information and resources on complementary and integrative health practices and therapies.
- American Holistic Medical Association (AHMA): The AHMA provides education, resources, and networking opportunities for holistic healthcare practitioners.
How does this relate to a billing company focused on acupuncture, chiropractic, and medical massage billing? While you are busy creating your business plan, your time does not need to be consumed by the tedious and complicated medical coding and billing process. By letting a trusted firm like Holistic Billing Services, handle your online appointments, SOAP notes, or your medical billing burden, your time, energy, and creativity are freed up to focus on what matters most: your patients. The friendly experts at HBS have decades of experience and are eager to help you succeed in EHR and medical billing! Contact us today to get started building a custom solution that suits your acupuncture practice needs and goals.
Cash flow is the amount of cash a business generates and uses in a given period. Understanding cash flow as part of your business plan is essential to ensure that the practice has enough money to pay its bills and invest in its future growth. Projecting cash flow in a medical practice can be daunting, but it is essential for the practice’s financial success. In this blog post, we will discuss the steps involved in projecting cash flow for a medical practice and provide tips for maintaining a healthy cash flow.
Step 1: Identify your sources of cash
The first step in projecting cash flow is to identify the sources of cash for the practice. These sources include patient payments, insurance reimbursements, and investments. Understanding the timing of these payments and any trends or fluctuations in the amount of cash received is essential. For example, if the practice experiences a spike in patient volume during the summer months, it will likely receive more money during this period.
Step 2: Identify your uses of cash
Once you identify the sources of cash, it is crucial to identify the uses of cash for the practice. These uses include expenses such as rent, salaries, supplies, and equipment. It is important to understand the timing of these expenses and any trends or fluctuations in the amount of cash spent. For example, if the practice plans to purchase new equipment, it will likely spend more money during the month or quarter in which you bought the equipment.
Step 3: Create a cash flow projection
With an understanding of the sources and uses of cash, the next step is to create a cash flow projection. This projection should include an estimate of the amount of cash received and spent in a given period. It is vital to have both expected and unexpected events in the projection and any trends or fluctuations in the amount of cash received or spent.
Step 4: Monitor and adjust your projection
Once you create the cash flow projection, it is essential to monitor it regularly and make adjustments as necessary; this may include adjusting the prediction based on actual results or making changes to the practice’s operations to improve cash flow. For example, if the practice is experiencing a cash flow shortage, it may need to increase its billing and collections efforts, recruit patients or reduce its expenses.
Tips for maintaining a healthy cash flow
- Review your billing and collections process: A poor billing and collections process is one of the most significant contributors to cash flow problems. Regularly reviewing and improving this process can help ensure that the practice receives payment for services promptly.
- Control expenses: Keeping expenses under control is essential for maintaining a healthy cash flow. Reviewing expenses regularly and finding ways to reduce them can help to improve cash flow.
- Communicate with patients: Clear communication regarding their financial responsibilities can help ensure that payments are received promptly.
- Maintain a good relationship with insurance companies: Building a good relationship with insurance companies can help ensure that reimbursements are received promptly.
- Keep an eye on future trends: Monitoring future trends in the healthcare industry can help to anticipate any changes that may impact cash flow.
In conclusion, projecting cash flow in a medical practice is a vital task that requires a thorough understanding of the sources and uses of cash. By following the steps outlined in this blog post and implementing the tips for maintaining a healthy cash flow, medical practices can ensure they have the resources they need to grow and succeed in today’s competitive healthcare landscape.
How does this relate to a billing company focused on acupuncture, chiropractic, and medical-massage billing? While you are busy projecting your cash flow, let us handle your EMR technology needs and the tedious and complicated medical coding, and billing process. By allowing a trusted firm like Holistic Billing Services, to capture your online appointments and SOAP notes, or offloading your medical billing burden, your time, energy, and creativity are freed up to focus on what matters most: your patients. The friendly experts at HBS have decades of experience and are eager to help you succeed! Contact us today to get started building a custom solution that suits your acupuncture practice needs and goals.
Opening a holistic healthcare practice is an exciting and challenging endeavor that requires careful planning and preparation. A business plan is a critical tool that can help you to organize your thoughts, set goals, and create a roadmap for your practice’s success. In this blog post, we will discuss the steps on how to establish a business plan for your holistic practice and provide some tips for creating a successful strategy.
Step 1: Research the market
The first step may seem obvious, but all too often is overlooked. When developing a business plan, you must first do your market research; this includes identifying the ideal patients for your practice, researching other holistic practices in your area, and understanding the trends and opportunities in the holistic healthcare industry. This research will help you know your target patient’s needs and concerns, allowing you to develop strategies that align with your strengths and interests.
Step 2: Define your business model
Once you understand your market, the next step is to define your practice’s business model; this includes identifying your services, setting prices, and determining how you will generate revenue. It is also essential to consider the costs associated with opening and operating your practice, such as rent, salaries, furniture, and equipment.
Step 3: Create a marketing plan
A marketing plan is a critical component of any business plan and is essential for promoting your practice and reaching your target audience. This plan should include strategies for getting your brand and message in front of potential patients, such as advertising, networking, and social media. In today’s world, it is critical to establish early how you will use social media and other digital marketing tools to promote your practice.
Step 4: Develop a financial plan
A financial plan is a crucial part of any business plan and is essential for understanding the costs associated with opening and operating your practice. This plan should include an estimate of your startup costs, operating expenses, and projected revenue. It should also have a projected cash flow statement, which will help you to understand your practice’s financial health over time.
Step 5: Review and refine your plan
Once your business plan is complete, regularly reviewing and refining, it is essential; this includes monitoring your progress, adjusting your plan as necessary, and seeking feedback from industry experts. It is also crucial to stay updated on industry trends and regulations and adjust your plan as needed.
Tips for creating a successful business plan
- Be realistic: Setting realistic goals and conservative projections for your practice is important; this will help you to avoid disappointment and make adjustments as needed.
- Please keep it simple: A business plan should be easy for someone else to understand and follow. Avoid using jargon or overly complex language.
- Seek feedback: Get input from industry experts, friends, and family to get an outside perspective on your business plan.
- Be specific about your goals and plans. Your goals should be measurable; this will help you stay focused and on track.
- Be flexible: Be prepared to adjust your business plan as necessary. The healthcare industry is constantly changing, and it is vital to adapt to changes.
Finally, developing a business plan for opening a holistic healthcare practice is a critical step in ensuring the success of your medical practice. By following the steps outlined in this blog post and implementing the tips for creating a successful plan, you can create a roadmap for your practice’s success and ensure you have the resources you need to grow and thrive in today’s competitive healthcare landscape.
Resources when establishing your business plan
- Small Business Administration (SBA): The SBA provides a wide range of resources and support for small businesses, including loans, grants, counseling services, and training.
- SCORE: SCORE is a national organization that provides free mentoring and resources to small business owners.
- National Small Business Association (NSBA): The NSBA is a nonprofit organization that provides advocacy, networking, and resources for small business owners.
- National Center for Complementary and Integrative Health (NCCIH): The NCCIH provides information and resources on complementary and integrative health practices and therapies.
- American Holistic Medical Association (AHMA): The AHMA provides education, resources, and networking opportunities for holistic healthcare practitioners.
How does this relate to a billing company focused on acupuncture, chiropractic, and medical massage billing? While you are busy creating your business plan, your time does not need to be consumed by the tedious and complicated medical coding and billing process. By letting a trusted firm, like Holistic Billing Services, handle your online appointments, SOAP notes, or your medical billing burden, your time, energy, and creativity are freed up to focus on what matters most: your patients.
The friendly experts at HBS have decades of experience and are eager to help you succeed! Contact us today to get started building a custom solution that suits your acupuncture practice needs and goals.
One of the quickest ways to ensure your healthcare revenue cycle is running smoothly is to utilize the most current medical billing codes for your practice. If you code for the wrong treatment, over or under code for services rendered, or submit your claims late, then you run the risk of delayed payment and a host of other issues.
If your holistic practice offers massage therapy treatments, then you’ll want to keep this list of massage therapy CPT codes and tips handy! Be sure to bookmark this page for easy reference so that you can enjoy a streamlined medical billing process.
Essential Massage Therapy CPT Codes
Some of the most commonly used CPT codes used by massage therapists are below:
- 97124 (Massage therapy): Describes work including effleurage, petrissage, and/or tapotement (stroking, compression, percussion) for every 15 minutes
- 97140 (Manual therapy): Includes therapy techniques, consisting of but not limited to connective tissue massage, joint mobilization and manipulation, manual traction, passive range of motion, soft tissue mobilization and manipulation, and therapeutic massage for every 15 minutes
- 97112 (Neuromuscular re-education): Entails the re-education of movement, balance, coordination, kinesthetic sense, posture, and proprioception in 15-minute intervals; examples include PNF (proprioceptive neuromuscular facilitation), Feldenkreis, Bobath, BAP’s Boards, and de-sensitization methods
- 97010 (Hot/cold packs): describes the application of moist heat or cryotherapy for relaxing muscle spasticity, promotion of vasodilation, increasing lymph flow, or other situations
- 97110 (Therapeutic exercise): use this code for therapeutic exercises applied to a single or multiple body parts to develop strength, endurance, range of motion, and flexibility within 15-minute intervals
Essential Modifiers for Massage Therapy CPT Codes
Sometimes it’s not enough to use the baseline massage therapy CPT codes – in which case, you’ll likely need to refer to these code modifiers:
- Modifier 59: This modifier for massage therapy CPT codes indicates that two separate but similar procedures were performed on the client within the same day or time span of a few days
- Modifier 52: Use this modifier if billing for a procedure that used a reduced modality as the provider saw fit
Billing Medicare: Timed vs. Untimed Massage Therapy CPT Codes
If your practice accepts patients who are covered by Medicare, then you’ll need to be mindful of the difference between billing for time or untimed massage therapy services.
Billing Medicare for Untimed Massage Therapy
When you choose to bill for untimed massage therapy services, you can only bill for one whole service. This means that no matter how much time you spend with your client, you’re only billing for one treatment as a whole.
Billing Medicare for Timed Massage Therapy Treatment
On the other hand, if you’re billing Medicare for a timed massage therapy treatment, then you get reimbursed based on the time spent 1:1 with the patient providing treatment. These timed codes can be billed multiple times per session.
Each code equates to 15 minutes of treatment; however, if the time spent with your client doesn’t result in an even amount of time divisible by 15, then you’ll use the 8-minute rule. Basically, after dividing the time of the session by 15, if the remainder you have is greater than 8 then you can round up and bill for an additional unit. If the remainder is 7 or less, then you’ll bill for the minimum number of units.
Here’s a handy table for referencing the 8-Minute Rule:
- 8-22 minutes: 1 Unit
- 23-37 minutes: 2 Units
- 38-52 minutes: 3 Units
- 53-67 minutes: 4 Units
Medical Billing Tips for Your Massage Therapy Practice
Keeping your healthcare revenue cycle in good health is no small feat; check out these tips for medical billing success:
First, Ensure Your Practice Is Appropriately Credentialed
Before you can bill insurance companies or government programs for your massage therapy services, your practice should be medically credentialed to bill as an in-network provider or enrolled to bill out-of-network. Credentialing is necessary for many commercial insurance companies, or government plans like Veterans Affairs. Typically, the process involves documentation and verifying all licenses, though the exact requirements differ from provider to provider.
Confirm Your Patient’s Insurance Eligibility Ahead of Time
A frequent problem when going through the medical billing process is when claims are denied or need to be reworked as a result of ineligible patient coverage information. Whether the patient is wholly ineligible for the services rendered or their information changed without being updated, this can result in delayed payments and the need to rework the claim. Be sure to confirm your patient’s information every time they come into your practice!
Be Careful to Avoid Overcoding
Due to the complexity of massage therapy insurance billing, overcoding is a common mistake. It’s important to be aware of the rules associated with all the massage therapy CPT codes to avoid delays.
For instance, you can only bill either one of codes 97140 or 97124; you won’t be able to bill for both. Likewise, CPT code 97010 for hot/cold packs is now mostly “bundled” with codes 97124 or 97140. This means you might not be able to bill a separate fee for this service.
Transform Your Medical Billing Processes With HBS!
Balancing your practice’s online appointments, SOAP notes, billing and coding while delivering care to your patients can be overwhelming but outsourcing your massage therapy insurance billing can save you time, energy, and optimize your revenue cycle management!
As an experienced EMR and insurance billing provider for holistic practices, Holistic Billing Services can help your practice navigate the insurance billing process to minimize denials and increase revenue. With a knowledgeable partner by your side, you can focus more on treating patients to help your practice grow rather than worrying about insurance billing.
To learn more about our massage therapy billing services, talk to one of our billing and coding experts today.
There are nearly 11,000 CPT codes to account for all the different variations of healthcare treatments. While your chiropractic practice will only need a fraction of these codes, it’s vital that the chiropractic CPT codes are current and accurately reflect the services rendered.
If you’re utilizing chiropractic CPT codes that aren’t appropriate or are keyed incorrectly, your reimbursements can be delayed or your claims can be rejected. In any case, this will disrupt your overall revenue cycle.
Since the CPT codes are updated to some degree every year, let’s review the new changes and essential codes for your chiropractic practice!
New Chiropractic CPT Codes and Changes for 2023
All chiropractic services rendered in 2023 must align with the patient’s condition and can only be billed if they are reasonably and medically needed.
Along with this, you’ll only bill for direct services provided to patients – care and treatment provided by the patient, unskilled assistant, or office technician without the supervision of a licensed provider won’t be recognized as professional therapy.
A majority of the CPT codes that were updated or revised for 2023 deal with simplifying the language used for evaluation/management (E/M) codes for:
- Inpatient and observation care services
- Consultations
- Emergency department services
- Nursing facilities
- Home and residence services
- Prolonged services.
The American Medical Association (AMA) has more details regarding the changes for these categories of care, but some highlights include:
- Editorial revisions to the code descriptors to reflect the structure of total time on the date of the encounter or level of medical decision-making when selecting code level for inpatient and observation care services
- Deletion of lowest level office (99241) and inpatient (99251) consultation codes to align with four levels of Medical Decision Making (MDM)
- Revision to nursing facility guidelines with new “problem addressed” definition of “multiple morbidities requiring intensive management,” to be considered at the high level for initial nursing facility care
- The domiciliary or rest home CPT codes (99334-99340) were deleted and merged with the existing home visit CPT codes (99341-99350)
- A new code (993X0) was created to be analogous to the office visit prolonged services code (99417); this new code is to be used with the inpatient or observation or nursing facility services
Essential Chiropractic CPT Codes and Modifiers for 2023
While there are numerous chiropractic CPT codes, there are four main CPT codes chiropractors use for reimbursements; each code represents a specific region of the spine that was treated. These main codes are as follows:
- 98940: Used for the examination, diagnosis, and manipulative treatment of one to two spinal regions
- 98941: Used for the examination, diagnosis, and manipulative treatment involving three or four spinal regions
- 98942: Used for the examination, diagnosis, and manipulative treatment involving five or more spinal regions
- 98943: Used to report chiropractic manipulation of one or more of the extra-spinal regions
There are additional two chiropractor modifier codes commonly used. These can be attached to certain CPT codes to tell insurance providers that some of the treatments the CPT code describes were slightly altered.
If your selected CPT code requires a modifier but you fail to include it, your claim will likely be denied by the insurance company:
- Modifier 25: This Modifier is used to report a significant and separately identifiable Evaluation and Management (E/M) service on a day when another service was provided to the patient by the same physician or other qualified healthcare professional
- Modifier 59: Use this Modifier to report a procedure or service that was distinct or independent from other non-E/M services performed on the same day
When billing for these chiropractic CPT codes, remember these points:
- Report the initial treatment procedure
- Report the date of the X-ray if it was applied, including the X-ray film
- If an X-ray is unavailable, a physician’s examination may be used to document subluxation. The physical examination record must reflect the subluxation.
- Report subluxation using the recommended ICD-10-CM code
- All treatment procedures should be categorized as maintenance therapy, chronic subluxation, or acute subluxation
Direct Patient-Chiropractor Care CPT Codes
When billing for chiropractic care, you can only quantify the time that is spent with direct patient-chiropractor care; the client waiting for equipment or resting in your office doesn’t qualify as direct care, so it can’t be billed.
Refer to these ranges of chiropractic CPT codes to find the one that is most appropriate for chiropractic services rendered:
- 97032-97039
- 97530-97546
- 97110-97150
Transform Your Medical Billing with HBS!
Staying on top of your chiropractic practice’s appointments, SOAP notes, billing, and coding, all the while delivering care to your patients can be overwhelming. Save time, energy, and streamline your revenue cycle management by bundling your practice management with outsourced insurance and Medicare billing for your chiropractic practice!
As an experienced EMR and insurance billing provider for holistic practices, Holistic Billing Services can help your practice navigate the billing process to minimize denials and increase revenue. With a knowledgeable partner by your side, you can focus more on treating patients to help your chiropractic practice grow rather than worrying about insurance billing.
To learn more about our chiropractic billing services, talk to one of our friendly billing and coding experts today!
Did you know that roughly 30% of medical billing claims are rejected? That’s a significant chunk of your overall healthcare revenue cycle that will cost you in the short and long run. These claims might be rejected for a few reasons – a key one which is inaccurate coding.
That’s why it’s essential for your acupuncture practice to leverage current CPT codes that accurately reflect the services rendered. Having to rework claims results in costly reimbursement delays plus it takes up your time and energy!
If your holistic practice continues to make mistakes with acupuncture CPT codes, you can have increased denial rates and declining insurance reimbursements, which could put your practice at risk. Accurate acupuncture CPT codes and billing practices can help ensure your holistic practice reaches its full revenue potential.
We want to help reduce your medical billing stress, so we’ve compiled a handy reference list of the acupuncture CPT codes to use in 2023. Be sure to bookmark this page so you can easily access it!
Top 4 Essential Acupuncture Billing Codes for 2023
The bulk of the services you will bill to insurance will likely fall under four essential acupuncture CPT codes. Since acupuncture services are always billed in 15-minute increments, your practice will use one code for the initial 15 minutes of service and then a separate code for additional units of time.
Your acupuncture CPT codes will only vary if you include electronic stimulation in your treatment.
- 97810 Initial Acupuncture: Initial 15-minute insertion of needles, personal one-on-one contact with the patient. (Do not report in conjunction with 97813; use one or the other.)
- 97811 Subsequent Unit of Acupuncture: Use one unit per each additional 15 minutes of personal one-on-one contact with the patient after the initial 15 minutes, with re-insertion of needles. (May be used in conjunction with either 97810 or 97813)
- 97813 Initial Acupuncture with Electrical Stimulation: Initial 15-minute insertion of needles, personal one-on-one contact with the patient. (Do not report in conjunction with 97810; use one or the other.)
- 97814 Subsequent Unit of Acupuncture with Electrical Stimulation: Use one unit per each additional 15 minutes of personal one-on-one contact with the patient, with re-insertion of needles. (May be used in conjunction with either 97810 or 97813)
Acupuncture CPT Codes for Medicare
January marks the three-year anniversary of Medicare expanding their coverage options to include acupuncture for treating chronic lower back pain. CPT codes related to billing Medicare for acupuncture treatments are as follows:
- 97810: Acupuncture, one or more needles, without electrical stimulation, initial 15 minutes of personal one-on-one contact with the patient
- 97811: Each additional 15 minutes of personal one-on-one contact with the patient, with re-insertion of needles
- 97813: Acupuncture, one or more needles, with electrical stimulation, initial 15 minutes of personal one-on-one contact with the patient
- 97814: Each additional 15 minutes of personal one-on-one contact with the patient, with re-insertion of needles
- 20560: Services with needle insertion(s) without injection(s) of 1 or 2 muscle(s)
- 20561: Services with needle insertion(s) without injection(s) of 3 or more muscle(s)
Prices will depend on the region of your holistic practice; look up specific codes based on your location here.
Acupuncture CPT Codes for Patients
Medical billing codes for patients can be broken down into two categories, new and returning patients:
2023 Billing Codes for New Patients
Use these acupuncture CPT codes for when your holistic practice receives new patients. As a reminder, a new patient is defined as a patient who hasn’t received professional services from you or another provider of the same specialty who has belonged to your practice within the past three years.
- 99202 Evaluation/Management (Expanded): Presenting problems are of low to moderate severity; requires an expanded problem-focused history, an expanded problem-focused examination, and straightforward medical decision-making; the provider typically spends 20 minutes face-to-face with the patient
- 99203 Evaluation/Management (Detailed): Presenting problems are of moderate severity; requires a detailed history, a detailed examination, and medical decision-making of low complexity; the provider typically spends 30 minutes face-to-face with the patient
- 99204 Evaluation/Management (Comprehensive): Presenting problems are of moderate to high severity; requires a comprehensive history, a comprehensive examination, and medical decision-making of moderate complexity; the provider typically spends 45 minutes face-to-face with the patient
Billing Codes for Returning Patients
These CPT codes for acupuncture can be used for your established patients. Returning patients are those who have received any professional services from you or another provider of the same specialty who has belonged to your practice within the past three years.
- 99212 Evaluation/Management (Limited): Presenting problems are self-limited or minor; requires a problem-focused history, a problem-focused examination, and straightforward decision-making; the provider typically spends 10 minutes face-to-face with the patient
- 99213 Evaluation/Management (Expanded): Presenting problems are of low to moderate severity; requires an expanded problem-focused history, expanded problem-focused examination, and medical decision-making of low complexity; the provider typically spends 15 minutes face-to-face with the patient
- 99214 Evaluation/Management (Detailed): Presenting problem(s) are of moderate to high severity; requires a detailed history, a detailed examination, and medical decision-making of moderate complexity; providers typically spend 25 minutes face-to-face with the patient
Medical Billing Codes for Physical Therapy Treatments
Acupuncture practices use a variety of treatments and modalities to help their patients; your practice may bill for the following:
- 20550 & 20551 Tendon Injection: Single tendon injection for the treatment of fasciitis. Could include multiple injections into a single tendon sheath (CPT code 20550) or the tendon origin (CPT code 20551)
- 20552 & 20553 Muscle Injection(s): Injections involving single or multiple trigger points. Could be used to treat one or two muscles (CPT code 20552) or three or more muscles (CPT code 20553)
- 97010 Heat Therapy: Application of a modality to one or more areas; hot or cold packs
- 97016 Cupping: The use of a vasopneumatic device may be considered reasonable and necessary for the application of pressure to an extremity for the purpose of reducing edema
- 97026 Infrared Therapy: The application of infrared therapy is considered medically necessary for patients requiring the application of superficial heat in conjunction with other procedures or modalities to reduce or decrease pain/produce analgesia or reduce stiffness/tension, myalgia, spasm, or swelling
- 97110 Therapeutic Exercise: One or more areas, every 15 minutes; therapeutic procedures to develop strength and endurance, range of motion, and flexibility with direct (one-on-one) patient contact
- 97112 Neuromuscular Reeducation: Treatments to restore movement, balance, coordination, kinesthetic sense, posture, and/or proprioception for sitting and/or standing activities with direct (one-on-one) patient contact
- 97140 Manual Therapy: Techniques such as mobilization and manipulation, manual lymphatic drainage, and manual traction, one or more regions, every 15 minutes with direct (one-on-one) patient contact
- 97124 Massage Therapy: Includes effleurage, petrissage, and/or tapotement (stroking, compression, percussion) with direct (one-on-one) patient contact
- 97530 Kinetic Activities: Use of dynamic activities to improve functional performance, every 15 minutes with direct (one-on-one) patient contact
Medicare Billing Codes for Principal Care Management (PCM) in 2023
Principal care management involves managing a single, complex chronic condition; the goal here is to deliver a focused treatment and management plan that addresses a patient’s chronic condition.
- 99424: Principal Care Management performed by a physician or non-physician provider for 30 minutes per calendar month
- 99425: Additional 30 minutes per calendar month
- 99426: PCM performed by clinical staff under the direction of a physician or other qualified healthcare professional for 30 minutes per calendar month
- 99427: Additional 30 minutes per calendar month
These codes will allow providers to report care management services for patients with chronic conditions, such as lower back pain, in an effort to improve monitoring these complex health problems.
Transform Your Medical Billing with HBS!
Balancing your acupuncture practice’s appointments, SOAP notes, billing and coding, all the while delivering care to your patients can be overwhelming. Save time, energy, and streamline your revenue cycle management by bundling your practice management with outsourced acupuncture insurance and Medicare billing!
As an experienced EMR and insurance billing provider for holistic practices, Holistic Billing Services can help your practice navigate the billing process to minimize denials and increase revenue. With a knowledgeable partner by your side, you can focus more on treating patients to help your acupuncture practice grow rather than worrying about insurance billing.
To learn more about our acupuncture billing services, talk to one of our friendly billing and coding experts today!
Your holistic practice’s success and longevity within your community are predicated upon a streamlined healthcare revenue cycle—part of that comes from understanding a couple of key financial metrics that you can use to evaluate your practice’s current performance! Being able to calculate and track the financial key performance indicators, known as KPIs, of your holistic practice means that you’ll be able to make changes where needed and be better informed of your business’s status.
Two key metrics to track are the gross collection ratio (GCR) and the net collection ratio (NCR); these might sound the same, but they track different aspects of your practice. Both are valuable for you to know and measure because they help fill in the picture of your practice’s financial health!
Keep reading to learn the difference between gross and net collection ratios, plus how to calculate them for yourself.
What Is Your Gross Collection Ratio?
Let’s start with the GCR: the gross collection ratio refers to your practice’s gross income or gross profit; this is the most simple measure of your practice’s profitability. This metric includes the direct cost of producing or providing goods and services but doesn’t include the costs related to running your practice like administrative expenses, taxes, and other potential expenses.
An important note regarding the gross collection ratio is that it doesn’t deduct write-offs, so it’s considered to be a less effective measure of the financial performance of your holistic practice compared to the net collection ratio. Without removing write-offs, refunds, and contractual or non-contractual amounts from the math, you can’t get a comprehensive insight into your practice’s income.
What Is Your Net Collection Ratio?
On the other hand, your practice’s net collection ratio is an essential metric that measures how effectively your practice is at collecting all legitimate forms of revenue. This rate indicates inefficiencies in the process; for example, if a practice is struggling to collect payment due to bad debt, late filings, coding inaccuracies, claim underpayments or some other type of revenue issue, then it will have a low net collection rate.
The ideal net collection rate to strive for is 90% or above since that reflects your practice is collecting on all forms of revenue that it should be; great! However, if you find that your holistic practice’s NCR is below 90% then it might be wise to perform an internal audit of your billing practices.
Why Are These Financial KPIs Important?
These financial KPIs are important to your holistic practice’s success because they both provide visibility into how your practice is actually performing in relation to how it should be performing after factoring in any refunds, write-offs, or contractual and non-contractual amounts.
You can’t know what to improve about your practice’s financial standing if you’re not sure how well you’re doing in the first place; knowledge is power, after all! Streamlining your net collection rate can reveal areas within your medical billing and coding processes that might need some more attention and therefore result in an improved overall healthcare revenue cycle that benefits your practice.
How to Calculate Your GCR
Let’s take a look at how to actually calculate your practice’s gross collection ratio; the GCR formula looks like this:
Gross Collection Rate = Total Payments / Charges *100% (for a specific time period)
The gross collection rate only shows what your practice is allowed to collect. For example, you may have charged $200 but you only collected $175 from your insurance payer due to the agreement or contract that you might have signed.
Following this logic, the $175 is below the gross rate.
How to Calculate Your NCR
Since the net collection rate is one of the most important financial metrics to track for your holistic practice, it’s important that you calculate it with frequency—typically about once a quarter is a good measure of your practice’s financial performance.
A low NCR should be seen as an urgent priority since that directly affects the financial standing of your business. Optimizing your net collection rate starts with understanding how to assess your net collection rate. Calculating the net collection rate involves several important steps:
- Identify the time period that you want to monitor (e.g., 90 or 120 days). Assess data from an earlier period in which the majority of claims would be closed and cleared; ~6 months back is advisable.
- Calculate total payments (from payers and patients) for the designated time period.
- Calculate total charges minus approved write-offs (e.g., due to contractual reasons, bad debt, professional courtesy discounts, etc.) for the designated time period.
- Divide your calculation in step 2 by your calculation in step 3. Then multiply by 100.
In the end, the formula looks something like this:
Net Collection Rate = (Payments / (Charges – Contractual Adjustments)) * 100%
Do this consistently (e.g., every 90 days) for a period of at least one year to get the most accurate average rate.
Once you determine how your baseline collection rate stacks up to that goal, use information from the holistic industry to compare it to industry averages. From there, set a collections metric objective based on how much you would like to see it go up and how this could affect your revenue stream.
Let Holistic Billing Services Handle Your Healthcare Revenue Cycle!
If your holistic practice is overwhelmed by the billing and coding processes, then turn to the experts at Holistic Billing Services to handle your healthcare revenue cycle! Our experts have experience in your specialty and we’re eager to help you thrive. Medical billing and coding is a complicated process that seems to change all the time with new regulations—let our team take that stress out of your daily workflow so you can focus on what matters most: delivering great care to your patients.