How to Code Confidently for Personal Injury Cases in Chiropractic Practice | Chiropractic CEU Online Posted on Sep 23, 2023
Set the Stage for Honesty and Transparency
CCEDseminars | Your #1 Destination For Chiropractic Continuing EducationIn the realm of Personal Injury (PI), the complexities of coding, charging, and billing serve as both an art and a science. Conducted proficiently, these processes enable chiropractors to strengthen a patient’s legal claim, thereby facilitating payment and minimizing disputes from various parties involved, be it the patient, their attorney, or the defendant’s insurance adjuster. Below are insights to help chiropractors navigate these challenges. Chiropractic CEU Online courses are a convenient avenue to remain compliant with standards of care!
Establishing Verifiable, Reasonable Fees
Your fees and charges will often come under scrutiny, particularly in personal injury cases. Here’s how to set your fees with confidence:
Base your fees on multiple factors: These can include your area of specialization, the location where services are rendered, the types of procedures performed, medical necessity, and the time spent on treatment. Use resources like UCR publications or FAIR Health Consumer to evaluate your fees.
Monthly Statements: Consistently send monthly statements to your patients and their attorneys to protect yourself from post-settlement disputes regarding your fees.
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The Art and Science of Coding in PI Cases
The coding process is intricate. It requires a solid understanding of both medical science and the particularities of personal injury cases. Some considerations:
Avoid Improper Codes: Using the wrong codes can undermine the value of the case.
Medical Necessity: Ensure that all treatments billed were medically necessary at the time they were administered.
Be Cautious with Multiple Codes: Overloading on codes can invite scrutiny and allegations of bill padding.
Prioritize Trauma Codes: These codes can increase the value of a PI case.
Never Upcode: This is a form of medical billing fraud and can severely compromise the integrity of your practice.
Per-Visit Fees: Ensure that your total charge per visit is reasonable.
Champion Transparency in Your Practice
Transparency is the cornerstone of ethical practice. It not only protects you but also fosters a culture of trust and accountability.
Use Clear Statements: Include explicit statements in your liens and all other billing documents to clarify payment expectations.
Follow the No Surprises Act: This mandates the provision of a good faith estimate (GFE) to patients, outlining all possible costs.
Maintain Updated Records: Should the treatment plan change and cause the initial GFE to fall short by at least $400, an updated estimate must be provided. Documentation with measurable clinical data is the key to predicting clinical progress and GFE. Chiropractic CEU online classes such as those taught on our platform are invaluable (Click HERE).
By adhering to these guidelines, you lay the groundwork for a transparent and accountable practice. Not only does this streamline the billing process, but it also sets the tone for your relationships with patients and attorneys alike, minimizing complications down the line.
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