Medicare Billing: 3 Tips For Your Holistic Practice

If you’re on the fence about opening up your practice to patients covered by Medicare, but you’re dubious of the extra workload dealing with billing Medicare for services rendered, then you’ve come to the right place.

Expanding your pool of patients to include those covered by Medicare is limited depending on your specialty—primarily acupuncture or chiropractic practices are covered by Medicare at this time—but can provide a great boost to your revenue cycle. Anticipating a headache when dealing with the medical billing process, however, is reasonable.

We at Holistic Billing Services understand the struggle, so let’s break down a few tips for the Medicare billing process!

What Types of Holistic Services Does Medicare Cover?

While Medicare’s coverage of complementary and integrated healthcare isn’t terribly comprehensive, there are a couple of holistic services that Medicare currently covers; these include:

Acupuncture

Acupuncture has been proven to be effective for treating a variety of ailments and chronic conditions. At present, Medicare beneficiaries may be treated for chronic lower back pain, defined as:

• Lasting 12 weeks or longer;
• nonspecific, in that it has no identifiable systemic cause (i.e., not associated with metastatic, inflammatory, infectious, etc. disease);
• not associated with surgery;  and
• not associated with pregnancy

Medicare will cover up to 12 visits in a 90 day period; if the patient demonstrates improvement, then Medicare will cover an additional 8 visits but treatment is not to exceed 20 treatments in an annual period.

The good news is that there are legislative efforts to greatly expand Medicare coverage for acupuncture! In July 2021, the Acupuncture for Seniors Act, legally classified as HR 4803, was introduced to Congress and would significantly broaden the scope of acupuncture coverage provided by Medicare.

Chiropractic Treatments

Did you know that Medicare has technically covered chiropractic treatments for 50 years?

In 1972, Medicare first introduced coverage with the limited scope of spinal manipulation; not much has changed since then, unfortunately.

However, much like the Acupuncture for Seniors Act would improve coverage for acupuncture services, there are promising legislative efforts to expand Medicare coverage of chiropractic treatments! The Chiropractic Medicare Coverage Modernization Act, legally identified as HR 2654, would enable patients under Medicare coverage to visit a chiropractor for their comprehensive range of services.

Such services might include manual manipulation of the patient’s spine and extremities, evaluation and management of conditions, diagnostic imaging, and the utilization of other non-drug treatments in an effort to combat prescription abuse and fight the opioid epidemic.

Essentially, this bill:

• Provides patient access to all Medicare-covered benefits as delivered by a chiropractor’s state licensure
• Categorizes a Doctor of Chiropractic (DC) as a “physician” in Medicare’s programming and thus expands their authority as recognized by Medicare
• Requires that DCs complete a documentation webinar
• Has bipartisan support and was introduced by 16 cosponsors from both sides of the political aisle

As a whole, this legislation would enable tremendously more access to all services provided by a chiropractor and thus empower chiropractors to treat a new range of patients who are covered by Medicare.

Medicare Billing: 3 Tips for Your Holistic Practice

When it comes to the Medicare billing process, follow these essential steps to streamline your holistic practice’s revenue cycle:

Submit Accurate and Complete Claims

One of the biggest tips for Medicare billing—and any kind of medical billing processes your holistic practice might handle—is to submit claims that have been coded correctly and to the fullest extent possible. Inaccurate or incomplete claims really throw a wrench in your practice’s revenue cycle by delaying payment and dedicating resources to reworking a claim that could have been better utilized elsewhere.

Medicare coverage and payments require an item or service:

• Meet a benefit category
• Isn’t specifically excluded from coverage
• Is reasonable and necessary

Be sure to employ the most current and comprehensive CPT codes needed, plus any further documentation required with the claim so that your submission can be addressed in a prompt manner.

Send Claims to the Appropriate Programs

Filling out claims correctly and completely is an essential foundational step for Medicare billing, but an important follow-up is making sure you’re sending that claim to the appropriate program pertaining to your patient.

For example, if your patient is enrolled in Medicare’s Fee-for-Service program, you’ll need to send the claim to your Medicare Administrative Contractor (MAC); on the other hand, if your patient is enrolled in a Medicare Advantage (MA) plan, then you’ll need to submit your claim to their MA plan directly.

A third option is that your patient might have primary coverage provided by another payer—known as the Medicare Secondary Payer (MSP) program—like an insurance company; in this case, you’ll need to submit the claim to the primary coverage provider first.

File in a Timely Manner

Medicare mandates claims are filed within 12 months or 1 calendar year; claims that are filed after this strict deadline are automatically denied. Keep in mind that this kind of denial isn’t the same as a determined rejection based on the claim itself—missing the window for filing is a denial that cannot be appealed.

Partner with Holistic Billing Services to Streamline Your Medical Billing Processes!

Want to optimize your practice’s revenue cycle? Ready to expand the range your holistic practice offers to your community by including acupuncture or chiropractic services? Partner with an expert medical billing firm that has specialized expertise in handling medical and Medicare billing experience.

At Holistic Billing Services, we deal exclusively with holistic healthcare practices that deliver acupuncture, massage therapy, and chiropractic treatments to communities around the country. Whether you have questions on chiropractic insurance billing or other methods to enhance your revenue cycle management, feel free to contact our team today and let us know how we can help your practice today!