Various reports show approximately 49% to 80% of insurance claims have at least one error. Errors that can cause your insurance claims to be denied or delayed. A successful acupuncture practice relies on accurate insurance billing, but how can you stay on top of it?

Eliminating these errors is critical to your bottom line, so it’s essential to address the most common medical billing mistakes.

Here are seven common mistakes with acupuncture billing and we have put together strategies to prevent them from impacting your billing process.

1. Incomplete Claim Information

Even a single empty or unchecked box on a claim can result in denial. Fundamental fields such as gender, date of birth, and the time of an accident or injury are often left blank. Ensuring that every required field is completed is crucial to prevent claim denials.

Why It’s Important: Incomplete claims lead to delays in payment, increased administrative work, and potential financial losses for your practice. Accurate and complete claim submissions are essential for maintaining a steady revenue stream and reducing unnecessary stress on your administrative team.

How to Prevent It:

• Use Digital Intake Forms: Implement digital intake forms where patients can enter their details directly. These details should automatically populate the patient chart and subjective section, reducing the risk of errors and ensuring that all necessary information is accurately captured from the start. This automation streamlines the intake process, minimizes manual data entry, and ensures that claims are complete and accurate.
• Use Advanced Software: If you’re working with electronic claims, ensure your acupuncture software flags any missing fields and requires users to input all necessary information before allowing submission. This automated check can significantly reduce the likelihood of incomplete claims.
• Implement a Review Process: Have a second set of eyes review each paper or electronic claim before submission. This additional review can catch missing information that might have been overlooked.

2. Miscoding and Typing Errors

Simply put, sometimes you just get things wrong. Whether it’s an unbundled code, a duplicate charge, a miskeyed patient name, or an incorrect date, even an accidental, honest mistake can be enough to derail an insurance claim.

When you’re heavily involved in acupuncture insurance billing—especially if you have other responsibilities—it’s easy to make a general error. Here are a few of the most common mistakes to avoid and solutions to prevent them:

– Submitting Wrong Information for Insurance, Patient, or Provider

• Common Errors: Incorrect names, addresses, wrong insurance plan name, incorrect NPI number, or policy numbers.
• Solutions: Implement a verification step in your workflow. Ensure that each piece of information is double-checked against patient records and insurance documents before submission. Utilize acupuncture billing software to autofill fields from verified patient information, reducing manual entry errors.

– Not Entering Codes at All in a Given Claim

• Common Errors: Missing acupuncture billing codes can happen when the person filling out the claim is rushed or distracted.
• Solutions: Implement a mandatory review step where a second staff member checks each claim for completeness before submission. Automated billing systems can also be set to flag incomplete claims, preventing submission until all required codes are entered.
  

– Submitting Incorrect CPT Codes

• Common Errors: Incorrect procedural coding can result from misunderstandings of procedures or typographical errors.
• Solutions: Use advanced acupuncture billing and coding system to prevent CPT coding errors. Encourage staff to use these tools regularly and provide ongoing education on proper CPT coding practices. Cross-referencing procedure notes with coded claims can also help catch errors.

3. Missed Filing Deadlines

Some payers have two-year “timely filing” windows for individual medical claims, whereas others give you just 30 days to file. If you fail to file a claim on time, you’re pretty much out of luck. Timely filing denials are among the most difficult to appeal. Here are some examples of common filing deadlines and solutions to prevent missed deadlines: 

Some payers have two-year “timely filing” windows for individual medical claims, whereas others give you just 30 days to file. If you fail to file a claim on time, you’re pretty much out of luck. Timely filing denials are among the most difficult to appeal. Here are some examples of common filing deadlines and solutions to prevent missed deadlines: 

Examples of Common Filing Deadlines:

• Medicare: Typically requires claims to be filed within 12 months from the date of service.
• Medicaid: Deadlines can vary by state but often range from 90 days to 1 year.
• Private Insurers: Deadlines vary significantly, with some as short as 30 days and others up to 2 years.

Solutions to Prevent Missed Filing Deadlines:

• Create a Master List of Deadlines:
• Keep a detailed list of your most common payers’ deadlines in an easily accessible location, such as a shared digital document in the office.

Implement Billing Workflow Automation

• Example: Use billing software that automates the tracking of claim deadlines and provides alerts as deadlines approach.
• Solution: Ensure your billing software is set up to generate reports on claims that are close to their filing deadline, providing your team with ample time to act. 

Audit Claims Regularly

• Schedule weekly or bi-weekly audits of all claims to ensure none are approaching their deadline without action.
• Use billing software that helps you claims that are ready to be submitted to insurance payers, or different claim statuses of those which you have already submitted.

4. Not Verifying Insurance Coverage

Failure to verify insurance coverage is the top reason for most claim denials. If a patient enters the office frequently, the staff may assume their insurance provider or coverage plan hasn’t changed and doesn’t check eligibility.

Since insurance information can change at any time, you must implement a verification step into the billing workflow for every single patient visit. This means checking for all four potential reasons for insurance-related denial:

Coverage Terminated or Otherwise Ineligible on Date of Service:

• Example: A patient’s insurance plan may have been terminated without their knowledge, resulting in a denial when a claim is submitted for a visit.
• Solution: Always verify insurance coverage before each visit, regardless of how frequently a patient comes in. Use an electronic verification system integrated with your acupuncture practice management software to check eligibility in real time.

Services Not Authorized:

• Example: A patient requires a specific treatment or procedure, but their insurance plan requires prior authorization, which was not obtained.
• Solution: Implement a checklist for your administrative staff to follow, ensuring that all necessary authorizations are obtained before providing the service. Train staff on the importance of this step and how to efficiently handle authorization requests.
• Services Not Covered by the Plan:
• Example: A patient’s insurance plan does not cover certain treatments or procedures, leading to a denial when the claim is submitted.
• Solution: Verify the patient’s insurance benefits for specific services during the scheduling process. Clearly communicate with patients about what their insurance covers and discuss potential out-of-pocket costs for services that are not covered.

 Maximum Benefits Reached:

• Example: A patient has reached the maximum benefit limit for their insurance plan, and any additional services will not be covered.
• Solution: Track patient benefits using your practice management software to alert staff when a patient is approaching their maximum benefits. Discuss alternative payment options with patients if they need further treatment beyond what their insurance covers.

5. Combining CPT Codes

Accurate coding for acupuncture services is essential to avoid claim denials. There are four specific medical billing codes for acupuncturists: two for manual acupuncture (97810 and 97811) and two for electrical acupuncture (97813 and 97814). These acupuncture medical billing codes represent the initial insertion of needles and subsequent sets.

Denials frequently occur when you combine electrical and manual acupuncture on the same visit.

According to CPT guidelines, there can only be one initial insertion of needles per session per day; any additional sets should be coded with the subsequent codes.

Therefore, you should never code 97810 and 97813 on the same claim. If the first set is manual, use code 97810, and for subsequent electrical sets, use code 97814. Similarly, if the initial set is electrical (97813), any subsequent manual sets should be coded with 97811 or 97814.

Correctly combining acupuncture billing codes ensures accurate billing and reduces the risk of claim denials for acupuncture services.

6. Missing Modifiers with CPT Codes 

Mistakes in acupuncture billing can often be traced back to the lack of proper CPT modifiers. Modifiers are essential for providing additional information about the service performed, which can significantly affect reimbursement. Inaccurate or missing modifiers can lead to claim denials or underpayments.

For example, in acupuncture billing, certain scenarios require specific modifiers to accurately convey the nature of the service:

• Modifier 25 is used when a significant, separately identifiable evaluation and management (E&M) service is performed by the same provider on the same day as the acupuncture procedure. This ensures that the E/M service is recognized and reimbursed in addition to the acupuncture treatment.
• Modifier GP: According to CMS, certain acupuncture medical billing codes are classified as ‘Always Therapy’ services regardless of who performs them. These services require a therapy modifier (GP, GO, or GN) to indicate whether they are provided under a physical therapy, occupational therapy, or speech-language pathology plan of care. For accurate reimbursement, the GP modifier is most appropriate, as it aligns with the therapy provider category “physical therapy.” For example, all codes from 97010 through 97799 (PT codes) billed to UnitedHealthcare and all their affiliates, Anthem plans, and VA (Veteran Community Care) require GP modifier.

Proper use of CPT modifiers is crucial for accurate acupuncture billing. Ensuring your billing staff is well-trained and aware of the correct application of modifiers can significantly reduce claim denials and improve reimbursement rates.

7. Lack of highest specificity

When coding for acupuncture insurance billing, it’s essential to provide precise details to ensure accurate reimbursement and avoid claim rejections. Here’s a breakdown of how to code acupuncture procedures effectively, including examples and solutions for common issues:

1. Specificity: Each acupuncture procedure should be coded with high specificity, including details about the body parts treated and the techniques used.
2. Code Selection: Choose the correct acupuncture billing codes that reflect the exact services provided. For acupuncture, the most commonly used codes are in the 97800-97804 range.
3. Documentation: Ensure thorough documentation of the treatment, including the number of needles used, the location of insertion, and any additional techniques or modalities applied.

Let’s take an example for Initial Acupuncture Treatment and how to document it

Description: An initial acupuncture treatment session including the insertion of needles at specific meridian points.

CPT Code: 97810 (Acupuncture, one or more needles; initial 15 minutes)

Detail Needed: Document the number of needles used, the specific points or meridians targeted, and the duration of the session.

Conclusion

Acupuncture insurance billing codes is crucial for maintaining a successful practice and ensuring better reimbursement rates. By avoiding common mistakes such as incomplete claim information, miscoding, missed deadlines, and improper use of acupuncture medical billing codes and modifiers, you can significantly reduce the likelihood of claim denials and delays.

Implementing the best billing strategies like using advanced billing software, conducting regular claim audits, tracking the insurance payments/denials, ensuring thorough documentation, and maintaining regular training for staff are essential steps in streamlining your billing process.

Whether you’re handling billing in-house or working with an acupuncture billing company, adherence to these best practices will help you stay ahead of potential issues and focus on providing excellent care to your patients.

zHealth has extensive experience working with acupuncture coding and billing. To learn more about how zHealth can help streamline your practice and accelerate your income, contact our team today.

You may also like to read:

Top Reasons Why Your Clinic Is Not Getting Paid For Acupuncture Services

7 Cost-Effective Ways To Market Your Acupuncture Practice

A Complete Guide to Acupuncture Billing and Coding

5 Tips To Grow Your Acupuncture Practice With zHealth Software