AT Denials: Chiropractic Billing and Active Treatment

Chiropractic care offers a valuable non-invasive approach to pain management and musculoskeletal conditions. However, navigating the intricacies of chiropractic billing, particularly Active Treatment (AT) and its documentation, can feel like traversing a labyrinth. Improper billing practices have placed chiropractic services under scrutiny, leading to high denial rates. Let’s look into the complexities of AT denials, equipping you with the knowledge to ensure proper reimbursement and continued focus on patient well-being.

The Chilling Effect of Improper Payments

A 2018 report by the Office of Inspector General (OIG) revealed a concerning trend: chiropractic services experienced an error rate of a staggering 41%. This translates to millions of dollars in improper payments annually. From 2010 to 2015, the situation was even worse, with error rates hovering between 43.9% and 54.1%. These statistics highlight the importance of understanding and adhering to proper billing protocols, particularly regarding AT.

Active Treatment vs. Maintenance Care

The distinction between Active Treatment (AT) and maintenance care is paramount for accurate billing. Here’s a breakdown:

Active Treatment (AT)

This applies when a patient receives chiropractic adjustments aimed at correcting subluxations (misalignments) and promoting functional improvement.

• Acute Care: Addresses new injuries or flare-ups of chronic conditions, with the expectation of significant improvement in a reasonable timeframe.
• Chronic Care: Manages conditions not expected to fully resolve but can experience improved function and pain reduction.
• Key Point: Documentation plays a critical role. Your notes should clearly demonstrate measurable improvement in the patient’s functional abilities.

Maintenance Care

Aims to maintain previously achieved functional gains and prevent future issues. While valuable, maintenance care typically falls outside the scope of services covered by insurance under AT guidelines.

Apply the AT Modifier

For successful chiropractic billing of treatments meeting Active Treatment criteria, use the AT modifier alongside the appropriate CPT code (e.g., 98940, 98941). This tells insurance it’s medically necessary.

Without the AT modifier, your claims are highly susceptible to denial.

Documentation- The Key to Reimbursement

Accurate and detailed documentation serves as the cornerstone of successful chiropractic billing, particularly for AT claims.

Here’s what you need to focus on:

• Functional Improvement: Your patient records should meticulously document how your treatments impact functional improvement or prevent deterioration within a reasonable timeframe. This could include range of motion assessments, pain scales, or specific functional activities the patient can now perform.
• Precision Matters: Ensure your documentation aligns precisely with Medicare’s established standards for Active Treatment. Familiarize yourself with Medicare guidelines to avoid potential discrepancies.

What Next?

By adhering to these essential strategies, you can navigate the often-daunting terrain of chiropractic billing and secure proper reimbursement:

• Utilize the AT Modifier: Properly coding your claims with the AT modifier significantly reduces the risk of denials.
• Consider Outsourcing Billing: Partnering with 24/7 Medical Billing Services can free up valuable time and resources for your practice. Chiropractic billing outsourcing company can manage the complexities of AT billing, allowing you to focus on delivering exceptional patient care.

In Summary

While navigating the intricacies of AT denials is crucial for financial viability, it’s equally important to remember the core purpose of chiropractic care and improving patients’ lives. 24/7 Medical Billing Service helps to implement these strategies, you can streamline the chiropractic billing process, ensuring proper reimbursement for your services and allowing you to dedicate more time to what truly matters and delivering quality care to your patients. Remember, it’s not just about numbers, it’s about facilitating positive change, one adjustment and improved function at a time.

See also: Why Does Your Chiropractic Practice Need An Insurance Billing Specialist?