Medicare is a public health insurance in the US. It was first introduced under the Social Security Association, but now is managed by the CMS. According to the CMS or Centers for Medicare and Medicaid Services, around 24% of the US population is covered under Medicare. It generally covers people above the age of 65 or people with disabilities.
A major part of the aged population believes in holistic medical services such as acupuncture, body massage, chiropractic care, etc. But it has always been a trivia, that which holistic services Medicare covers. Since the Health Legislation Amendment Bill 2018, Medicare has been increasing the support for holistic services, alternate therapies, home healthcare services, etc. In July 2021, the coverage for acupuncture was increased following the introduction of Acupuncture for Seniors Act. Chiropractic care is also on the verge of getting covered under Medicare with the introduction of Chiropractic Medicare Coverage Modernization Act 2021. Hence, it is ideal than ever to welcome the patients covered under Medicare into your Holistic practices.
Before understanding how you can revamp your holistic practice for Medicare billing, let's first look at the prominent services which are covered under Medicare. Acupuncture and Chiropractic care are two of the most widely practised holistic services in the country. The popularity of acupuncture is increasing in the US. Infact, in 2007, around 14 million people in the US were using acupuncture. Similarly, chiropractic care is also seeing an improved acceptance. According to the ACA or American Chiropractic Association, around 35 million people get streat under chiropractic care annually. Because of this, Medicare has extended the plans to cover these services.
Now that you know about growing coverage for holistic services. Let's go through a few suggestions to revamp your holistic practice for getting billed under Medicare. These suggestions are bound to assist you in getting reimbursed for the service you provide.
Documenting the patient's visit throughout the medical care is the key to having a successful claim filing. When a patient books an appointment, the first action you should do is to check the patient’s eligibility and benefits. This becomes extremely important for holistic practice. This is because not all the plans under Medicare cover for holistic practices.
Many plans under Medicare have certain levels of eligibility which a patient should meet. Sometimes, a patient has to meet a certain deductible for getting holistic services covered under their Medicare plan. Hence, a holistic medicine practitioner should always verify patient eligibility and benefits, at least 48 hours before a visit.
Accurate claim filing
Insurance claim filing is a complex process. While filing a claim, you have to make sure that you are accurately documenting the patient information, are making an error-free charge entry, are using accurate medical codes, and are filing the claim under a right program.
Medical coding has the highest importance in the medical billing process. While inputting the codes for services rendered, one has to make sure that they are following a latest database. The codes should accurately mention the diagnostic and therapeutic procedures.
Medicare has various programs for covering different types of patients based on their insurance plans. It is necessary to file the claim under the respective Medicare program for getting it approved. There are various plans such as Fee-for-Service plan, Health Maintenance Organization, Special Needs Plan, etc. Whichever the program your patient is enrolled in, you have to file the claim under that program.
Following the time window and taking follow-ups
Medicare has a tight set of deadlines for filing the claims. These deadlines need to be met at all costs for getting your claims approved. You can have accurate documentation, error-free charge entry, or perfectly used medical codes, but if you miss the filing deadline, your claims are bound to get rejected without any hope for appeal.
Beside deadlines, another important aspect of claim filing is taking follow ups. Follow ups allow you to keep track of denied claims, pending payments, and claims in process. For claims in process and denied claims, you have to take follow ups from the payor for keeping track of the process. Also for approved claims, taking follow ups from the payor ensures getting paid quicker. Follow-ups also help by sending a gentle reminder to the patient in case they are liable to pay for the service.
Managing all the above mentioned steps alongside managing your practice is hard. But it is necessary for expanding your practice and increasing your revenue. Hence, if you are looking to expand your practice, you might want to outsource your medical billing to a third-party firm like VLMS Healthcare.
We at VLMS Healthcare, regularly deal with the hassle of filing insurance claims. We take care of each and every aspect of your medical billing for you, allowing you to efficiently focus on providing excellent care to the public. And if you have any questions on how you can manage to do it fluently, please reach out to us.