Decoding the Complexities of Chiropractic Billing and Coding

With over 16 years of chiropractic practice, Dr. Marty Kotlar from Target Coding brings a unique blend of real-life experience and coding expertise, holding certifications as a Professional Compliance Officer and Billing and Coding Specialist. In this conversation with Genesis, Dr. Kotlar shares his insights and sheds light on the top three mistakes chiropractors commonly make in billing, coding, and compliance.

Insurance Practices

Dr. Kotlar kicks off our discussion by emphasizing the importance of meticulous tracking in insurance-based practices. He introduces the concept of an insurance tracking spreadsheet, stressing the need to record every payment accurately to avoid potential discrepancies. He also touches on common issues such as copay discrepancies and claim processing errors, urging practitioners to ensure they receive rightful reimbursement.

Moving on, Dr. Kotlar delves into the world of codes. He discusses the nuances of time-based codes and non-time-based codes, providing valuable insights into maximizing reimbursement through proper coding. Exploring the intricacies of time-based codes like therapeutic exercises (97110), he unveils the critical factors providers should consider for accurate coding.

In the final segment of insurance practices, Dr. Kotlar addresses the challenge of maximizing reimbursement. He shares pearls of wisdom, including the often-overlooked activities of daily living (ADLs) code (97535) and the significance of extremity adjustments. By unraveling the complexity of re-exams and other reimbursable services, Dr. Kotlar provides actionable strategies for practitioners aiming to optimize their revenue in insurance-based practices.

Personal Injury (PII)

Shifting the focus to personal injury (PII) practices, Dr. Kotlar enlightens us on the crucial role SOAP notes play in building strong cases for attorneys. He emphasizes the importance of documenting “duties under duress” and “loss of enjoyment of life,” elements that can significantly impact the patient’s life post-accident.

Dr. Kotlar discusses the potential pitfalls associated with overprescribing in PII cases, cautioning against unnecessary procedures or devices. He sheds light on compliance challenges related to devices like back braces, TENS machines, and home traction units. Additionally, he underscores the necessity of thorough follow-ups to prove the clinical necessity of prescribed items.

In this segment, Dr. Kotlar unveils the complexities of fee schedules, dual fee schedules, and the state-specific regulations chiropractors must navigate in the PII landscape. By addressing these challenges, he equips practitioners with the knowledge needed to build strong PII practices while ensuring compliance with legal and ethical standards.

Cash Practices

Dr. Kotlar concludes our conversation by exploring the nuances of cash practices. He starts by cautioning against misleading advertising practices, emphasizing the need for compliance even in cash-based settings. The discussion then pivots to the intricacies of prepaid plans, highlighting the potential risks associated with mishandling prepaid funds and the necessity of putting money in escrow.

The conversation takes an insightful turn as Dr. Kotlar delves into the complex realm of discounts in cash practices. He demystifies the restrictions and allowances surrounding discounts, providing practitioners with a clearer understanding of how to navigate this aspect successfully.

The final focus of our discussion centers on distinguishing between medically necessary care and maintenance or wellness care in cash practices. Dr. Kotlar outlines the importance of accurately coding services based on the nature of the patient’s visit, offering practical guidance for maintaining compliance and avoiding pitfalls.

Conclusion:

As our enlightening conversation with Dr. Marty Kotlar concludes, chiropractors and practitioners in allied fields gain a wealth of knowledge to enhance their billing and coding practices. Dr. Kotlar’s expertise and insights serve as a compass, guiding practitioners through the intricate landscape of compliance, reimbursement optimization, and ethical considerations. In the ever-evolving field of chiropractic care, staying informed and proactive is key, and Dr. Kotlar’s wisdom provides a valuable roadmap for success. Stay tuned for Part 2 of this conversation to be released next week!

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