Are MT able to bill insurance companies for their services rendered in a chiro office?

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Permalink Reply by jen on February 12, 2010 at 9:54pm

I think it depends a lot on where you live.

Here in WA state, LMPs can apply to be credentialed providers with insurance companies, and once accepted, can bill insurance as preferred providers.

It is my understanding that if you are in a state that doesn't have this situation, that any billing done has to be done under the umbrella of an MD or chiro.

Permalink Reply by Serenity Achieved! on February 12, 2010 at 10:10pm

In PA only a doctor can submit claims to health insurance companies directly.

However, people with flex spending health accounts or certain insurance plans can come see you and get reimbursed with a receipt that has a Dx code along with the treatment rendered and the fees paid. Depends on their plan how it works.

I can submit directly to auto insurance or workers comp with a script from a doctor and the required paperwork.

Permalink Reply by Jacqueline M Curan on February 14, 2010 at 7:15pm

Carla in NC it is illegal for the chiropractor to bill insurance for my services because i am not an employee. Many chiropractors have been bitten by this with ensuing fraud charges. My clients can be given an insurance form with the appropriate numbers and my tax id # and if they choose they can submit for reimbursement.
The Federal IRS has a publication entitled "Independent Contractor or Employee..." This provides a good outline about the roles of each.

Permalink Reply by Carla R Stingle on February 15, 2010 at 7:43am

Thanks for the information reguarding the pub from the IRS. I will definetly look at that. It may answer a lot of my questions.

Jacqueline M Curan said:

Carla in NC it is illegal for the chiropractor to bill insurance for my services because i am not an employee. Many chiropractors have been bitten by this with ensuing fraud charges. My clients can be given an insurance form with the appropriate numbers and my tax id # and if they choose they can submit for reimbursement.
The Federal IRS has a publication entitled "Independent Contractor or Employee..." This provides a good outline about the roles of each.

Permalink Reply by Michael A. Breaux on February 27, 2010 at 6:01pm

I work in southwest Louisiana and each state is different, but here's what I've learned. It's best to use an electronic billing company or to let the chiropractic office staff handle the billing for you. Insurance is not paying what they were 20 years ago and the market is fiercely competitive. Your best bets are to bill PERSONAL INJURY cases where someone has been hurt in a car, maritime, or workplace accident and someone else is liable. These pay 100% of your charges with no deductible or copays and are the least hassle. If an attorney is involved,make sure you have a clinic lien signed so that your portion of the settlement goes to you and not the client. They often spend it thinking it is theirs. The downside of PI (personal injury) cases is that they often take a year or longer to settle. I'm on salary at my office so get paid regardless and the chiropractors have to wait for their money, but, they get about 75% of the fee. I'm happy to get about $40.00 per hour plus benefits and paid holidays and not have to worry about my bills.

Major medical does pay for "manual therapy" using the 97000 series treatment codes, but its quirky. Your doctors have to be trained in diagnosis pointed billing as most insurance will not pay both a massage therapist and a chiropractor to treat the cervical region of the same patient on the same day. The treatment team must coordinate services so that when the chiropractor does a cervical adjustment, the massage therapist is working on a different area such as the lumbar and billing it and vice versa. Hope this helps!