Education Assistance for Claims Edit Denials

Education Assistance for Claims Edit Denials

The BCBSIL claims processing protocol that began in November 2017 continues to create an unjustified barrier to care for BCBSIL patients and negatively impacts the day-to-day operations of our doctors’ offices. As we reported in our release in March, the Illinois Chiropractic Society is continually looking into other recourse that may be available to our members and the association as a whole, and we have not ruled out any options.

As a part of this process, the ICS has added physician education specifically targeted at this issue. These classes have been designed to assist doctors in their ability to provide necessary, evidence-based, efficient treatment for their patients; to maximize appropriate reimbursement; and to succeed in appeals following claim denials. These courses are free for ICS members.

The following three courses are designed to assist doctors in combating denials resulting from application of claim edits:

Evidence-based Therapeutic Exercise that Gets Results and Fewer Denials (April 24) – This course will cover the appropriate utilization of active care exercise in your daily practice. They will show specific and
proven exercise regimens for managing the underlying causes of the most common neck and back conditions. Attendees will learn simple ways to efficiently incorporate into daily practice medically indicated, effective exercise protocols that do not require billing modifiers.

Rock Solid Documentation and Billing of Therapeutic Procedures (May 1) – This course will cover: billing and documentation requirements for therapeutic exercises, manual therapies, and other modalities; identification of procedures that require modifiers and when those modifiers are appropriate; and proper documentation to overcome common reasons for claim denials. Register Here. [link needed for completion]


E/M Practices, Documentation, and Coding for Denial Prevention (May 8)– This course will simplify evaluation and management (E/M) coding and documentation by using a relatively easy tool. Attendees
will be able to quickly determine the appropriate level of E/M and document effectively for each level. With this information and the use of correct documentation for each E/M claim, our doctors will be better
able to defend E/M denials from carriers. Register Here. [link needed for completion]


We will continue to notify members when new information is available.

About Author

Marc Abla, CAE

Marc Abla began working at the Illinois Chiropractic Society in 2002 and became the Executive Director in 2008. He brings his extensive financial, administrative and association experience to the ICS. He is a Certified Association Executive and a graduate of the Certified Leadership Series through the Illinois Society of Association Executives. Additionally, he is a member of the Illinois Society of Association Executives, the American Society of Association Executives, Association Forum, Congress of Chiropractic State Associations, and the American Chiropractic Association.


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