Re: BCBS Billing Question--Caution is in order

[Guest guest]

While I agree generally with most of what's been said regarding this subject, I implore you all to exercise considerable caution. I personally believe that BCBS is in certain respects "out of control" simply because no one, and certainly no one at the Insurance Division, has called them or is willing to call them on the carpet for a myriad of what I consider to be highly questionable business practices. So far, I'm in that group of "unwilling actors" as well, although I've been fixing to sue them for a few months on another matter (still fixin' to do so), but I've got to find the 100+ hours of free time to embark on that noble crusade. Blue Cross will tell you that "Well, what we are doing is legal, because we disclosed it to the Insurance Division, and our policy was approved by them, not rejected, blah, blah, blah. If you call and complain to the Insurance Division, they will simply respond by telling you that they don't approve the legality of any policies or practices and "We conveyed your concerns to BCBS, and they claim that they have done nothing wrong, so we are closing our files on this matter."

So here's my word of caution. I believe that BCBS has a legal/enforcement/retaliation department that is staffed with energetic folks with nothing better to do than make your life a living hell with the Board, with your patients, and with you. Anybody recall the spat/war over overpayments for massage therapy and the hell that many of your brethren underwent with BCBS a couple of years ago? Blue Cross has many insurance policies that purport to not provide any coverage for chiropractic care. If you are providing physical therapy, arguably there would be coverage under certain circumstances. However, according to BCBS, arguably there is not. So whatever you do, make sure that you are doing it completely above board, in the open, and well documented. It's not that you legally must do anything extra, it is simply that Blue Cross is fully capable of accusing you of fraud and other acts of evil for billing for and receiving payment for services they will later claim you knew were not covered. For example, Blue Cross took the position a few years ago that on policies that did provide chiropractic, it would only pay for therapy that was administered by a D.C., and not pay for therapy that was provided under the supervision of a D.C. by a C.A. or L.M.T.

There are several doctors in this state who have lost sleep worrying about having to defend themselves from retaliatory attacks from the likes of BCBS. So if you plan on taking a noble and principled position with BCBS, plant your feet firmly in the sand.

Best Regards, G. , Gatti, Gatti, et. al.

From: [mailto: ] On Behalf Of joe medlinSent: Wednesday, September 17, 2008 8:35 AM ; lauren_mccabeSubject: Re: Billing Question

You're right. I was on the phone with them yesterday and asked this question while i was there. They said it should be a PT visit if thats what was provided.

That being said, there are many out of state plans and variations that could apply it differently, re-imburse you differently etc. Perhaps in this particular case it is an Amica thing. Franchesca, check with your BCBS provider representative to nail down an answer. If you get one, please update us.

Good times.

ph Medlin D.C.Spine Tree Chiropractic1607 NE Alberta St. PDX, OR 97211www.spinetreepdx.com

Billing Question> > > Hi all,> > This may be a silly question but I just wanted to make sure. Right now I see a patient for attended stim, trigger point work and therepeutic exercises. She comes in far more often for that than for adjustments at this point in her care. Her insurance only approves 12 chiropractic visits a year. She has 60 approved PT visits. Since the stim and exercises fall under physical therapy can they be billed that way or is a chiropractor doing that still considered billing for chiropractic services.? We had to take PT boards to be able to do this in the state of OR, so do we bill differently when no adjustment is performed? Obviously the codes change but will the insurance company look at it any differently? My patient told me and one of the people at the billing company told me if I am just doing PT and not adjusting it could be billed as PT. Thoughts? Suggestions? This is with BCBS with an intermediary of amica so they put the cap on these things not BCBS. > > Respectfully,> > > Dr. Franchesca Harper> Functional Pain Solutions> 6956 SW Hampton St> Tigard, OR 97223> p. 503-443-6100> f. 503-443-1280> > > > > > > > --------------------------------------------------------------------> Want to do more with Windows Live? Learn "10 hidden secrets" from . Learn Now>

[Guest guest]

Thanks and your words of caution are appreciated. Personally I rarely if ever provide physical therapy without chiropractic care, and never accept a patient that has PT coverage without chiro coverage. That being said, the issue at hand i presumed was a case in which the patient had both PT and CHiro coverage and we're only trying to find out where the visits are suppose to go. A DC does indeed take a risk in applying PT to a patient without chiro coverage. Problem is that it depends on who you talk to, which is unacceptable.

Contacting your BCBS representative in my opinion is the best way to begin and to play it safe.

ph Medlin D.C.Spine Tree Chiropractic1607 NE Alberta St. PDX, OR 97211www.spinetreepdx.com

Billing Question> > > Hi all,> > This may be a silly question but I just wanted to make sure. Right now I see a patient for attended stim, trigger point work and therepeutic exercises. She comes in far more often for that than for adjustments at this point in her care. Her insurance only approves 12 chiropractic visits a year. She has 60 approved PT visits. Since the stim and exercises fall under physical therapy can they be billed that way or is a chiropractor doing that still considered billing for chiropractic services.? We had to take PT boards to be able to do this in the state of OR, so do we bill differently when no adjustment is performed? Obviously the codes change but will the insurance company look at it any differently? My patient told me and one of the people at the billing company told me if I am just doing PT and not adjusting it could be billed as PT. Thoughts? Suggestions? This is with BCBS with an intermediary of amica so they put the cap on these things not BCBS. > > Respectfully,> > > Dr. Franchesca Harper> Functional Pain Solutions> 6956 SW Hampton St> Tigard, OR 97223> p. 503-443-6100> f. 503-443-1280> > > > > > > > --------------------------------------------------------------------> Want to do more with Windows Live? Learn "10 hidden secrets" from . Learn Now>