The traditional Chinese therapy of acupuncture has been an acceptable treatment for various maladies, the most common being pain relief. While there are insurers that cover acupuncture services, many providers are frustrated with the ongoing denials of their claims. Skyline Medical Billing Management describes some of the reasons acupuncture claims are being denied at your Prescott practice.
Checking coverage for acupuncture
What the provider needs to understand is that acupuncture coverage is all diagnosis driven. It is important that the staff, when checking coverage, determine how many visits a patient is allowed for the fiscal or calendar year, and if those visits have been used. With some insurance companies, the information on coverage is available online.
What is covered
Some insurance companies will verify that the patient has coverage for acupuncture, but only when prescribed by their physician to treat nausea resulting from chemotherapy. In other cases, coverage is limited to treatment of chronic pain that is not responding to more conservative treatment options. It is imperative that the correct question is asked: Does the insurance company cover acupuncture for pain management?
What is NOT covered
With mental health issues on the rise and people becoming more aware of the side effects of prescription drugs, alternative treatments like acupuncture are being sought. Unfortunately, stress, anxiety and anger are not considered medically necessary. In addition, allergies and coughs do not fall under a covered diagnosis code.
Limited number of diagnoses with insurance companies
There are several insurance companies, including Cigna and Aetna, that only accept a limited number of diagnoses. Blue Cross/Blue Shield and UnitedHealthcare tend to reimburse for a wider variety of diagnosis codes.
Advance Beneficiary Notice of non-coverage (ABN)
If you are contracted with the insurance company and you know the services will not be covered by the patient’s insurance, it is in your best interest to have the patient sign an advance beneficiary notice of non-coverage (ABN). An ABN is a waiver of liability that providers are required to give a patient for services provided that may not be covered or considered medically necessary. The ABN needs to be signed before the services are rendered.
As simple as it is to bill acupuncture, it can be very frustrating if you don’t have a good understanding on the ins and outs of covered codes. For more information on how we can assist you in your Prescott practice, call the billing experts at Skyline Medical Billing Management today at 928-227-1167.