Chiropractic Billing Secrets - What Insurance Companies Don't Want You To Know - Tactic 2 And 3

Beating the insurance companies at their own game is tough work, especially when you don't know the rules of the game you are playing. This article series will arm you with the basic strategies applied by insurance companies to tilt the scales in their favor.

See the Strategy Review in article number one before proceeding further.

Tactic 2 - They Make The Rules

To begin with, there is no reason insurance companies should delay payment on a claim at all. Technically speaking way more complicated transactions happen every day on wall street. The difference is, by law, everyone has to be paid by the end of the business day on wall street. What's the difference here? Power. They have the money, they have the power, they make the rules, they get to delay, but not forever. So the first way to rig a system is to gain the power to make the rules. The submission process and the payment process are intentionally way more complicated than they need to be. That is their second tactic. First the power is gained then it is used.

Tactic 3 - Coding

Here is one place where they exercise their power by making simple things complicated. It seems pretty simple on the surface. There are a few diagnosis codes, a few procedure codes and then maybe a few modifiers. But then add diagnosis code linking. Most docs don't even know what this means. This means if you have four diagnosis code and five procedures you can designate which diagnosis code goes with which procedure. Shoulder pain goes with the extremity adjustment. To get paid for that extremity code though, some insurance companies, not all, require a specific modifier. You only have four diagnosis to work with. What if you have five procedures and you can't link all of the procedures to the diagnosis codes that you have? You would like to add more but you can't. Some diagnosis code are not accepted for extremity adjustments. The result here is simple. We went from a few codes to thousands of combinations. It is ambiguous leaving the doctor confused delaying not only payment, in some cases outright claim denial, but delay in the submission to begin with. It is not by accident. After seeing hundreds of thousands of claims being processed and denied I am sure of it. Delay is how they make their money right?