8 Ways to Overcome Chiropractic Billing Challenges

Effective billing and revenue cycle management is essential to the success of any health and wellness practice. And while healthcare billing can be complex in any industry, chiropractors may face a unique set of challenges.¹ Read on to discover common obstacles in chiropractic billing — and practical tips to help you move past them.

Common Chiropractic Billing Challenges

To help ensure the financial health of your practice, you’ll need to navigate common chiropractic billing issues. These may include:²

• Insurance limitations. Coverage for chiropractic care can vary from payer to payer (and patient to patient), adding to the complexity of insurance billing and claims processing. And failure to verify each patient’s coverage limitations or obtain required pre-authorizations can lead to unpaid claims and unhappy patients.

• Coding errors. Incorrect use of codes is one of the most common chiropractic billing mistakes, and can potentially lead to claim denials, inaccurate payments, payment delays or penalties. Errors may include adding incorrect modifiers to chiropractic procedure codes; using incorrect or outdated codes that don’t represent the services rendered or are no longer valid; using codes that indicate a higher level of service than provided; using multiple codes for individual parts of a procedure when a single code is available; or not coding for all services provided

• Inadequate documentation. Insufficient detail to support the necessity of chiropractic therapies — including a lack of documented patient history and rationale for treatment — can lead to claim denials and potential third-party payer repayment demands.

Streamlining Chiropractic Billing and Collection Processes

To help enhance the accuracy of your chiropractic billing, reduce the chance of claim denials and decrease your days in accounts receivable, consider these eight strategies to optimize your billing and collection processes.¹

1. Master chiropractic coding and documentation

Accurate coding and documentation is critical to the financial health of your chiropractic practice.² Try these helpful tips:

• Use accurate codes. Coding precision may result in higher reimbursements, so be sure to use the correct International Classification of Diseases (ICD) codes for diagnoses and Current Procedural Terminology (CPT®) codes for procedures.¹ Include the appropriate CPT modifiers to provide additional information to payers about the services rendered and help ensure that claims are reimbursed properly.³ You may want to have multiple staff members review claims to correct any coding errors before submission.

• Regularly review coding updates. Chiropractic billing codes may change, so it’s important to stay up to date on the latest guidelines. This can help ensure accurate billing and minimize the chance of claim denials.⁴ Consider reviewing coding resources, attending continuing education courses and using billing software that can alert you to potential errors.²

• Prioritize comprehensive documentation. Thorough documentation is essential to justify the necessity of chiropractic care and support claims.² Comprehensive patient records should include detailed assessments, treatment plans and progress notes. Use standardized documentation templates to help ensure patient notes are consistent and complete, and regularly review patient records to address any gaps in documentation.

2. Optimize patient financial communication

Clear patient communication is vital for successful chiropractic billing.⁴ Here are some tips to help you optimize communication in the patient billing process:

• Explain financial policies up front. Be sure to outline your practice’s billing procedures and payment expectations during the first visit, including patients’ financial responsibility for any services not covered by insurance. This type of clear communication may help prevent future billing disputes.¹

• Educate patients on insurance coverage. Help patients understand what their insurance plan covers and how copays, deductibles and coinsurance may apply. This may help patients plan for treatment costs and avoid unexpected bills.⁵

• Provide transparent cost estimates. Healthcare cost transparency can foster trust between patients and providers, boosting patient satisfaction and helping reduce churn. Providing clear and up-front cost estimates also establishes patient accountability, which may lead to your practice being paid in a timelier manner.⁵

3. Be proactive with denial management

Claim denials can be frustrating, time-consuming and financially draining.¹ Consider these ideas to help your practice manage and minimize denials:

• Investigate common causes. It’s wise to regularly analyze denials to discover the root causes and help prevent future errors. Common causes of chiropractic claim denials may include incomplete or incorrect documentation, lack of prior authorization, a claim filed after the payer-determined time limit or noncovered or excluded services.⁶

• Develop a structured denial resolution plan. You can follow these steps to appeal a claim denial:
  • Double-check all ICD codes, CPT codes and modifiers for accuracy.
  • Ensure the procedures billed are supported in the patient health record and progress notes.
  • Write an appeal letter, citing any professional guidelines or sources (such as state insurance regulations) that show the care is necessary and beneficial.

• Follow up consistently. Lack of follow-up is one of the biggest reasons for lost revenue and high accounts receivable.⁷ To help ensure timely reimbursement, follow up on all claims and communicate with payers and/or patients about any outstanding issues. Consider using automated systems to regularly track and follow up on all claims. In addition, train staff on the appeals process and provide access to any documentation, resources and templates they may need.

4. Implement effective collection strategies

If you want to optimize revenue cycle management in your chiropractic practice, consider these collection strategies:

• Collect payments at the point of service. Train your front desk staff to collect any copays, deductibles and outstanding balances during appointments. Point-of-service collections can help ensure your practice’s financial health and sustainability, allowing you to stay focused on providing patient-centered care.⁸

• Establish a routine for collection efforts. After the visit, create an itemized bill that shows each service and its cost. Detailed invoices can help patients understand chiropractic charges and facilitate payment.⁴ For unpaid invoices, consider sending patient payment reminders at 30, 60 and 90 days.

• Offer flexible financing options. According to Synchrony’s Healthcare Journey Research study, 1 out of every 2 patients surveyed struggles to pay for out-of-pocket health and wellness expenses.⁹ A patient financing solution like the CareCredit credit card can help chiropractic patients fit the cost of care into their budget* — and it can help your office spend less time and effort on collection.

• Offer financing for bundled services. Chiropractic patients may also use CareCredit to pay in one transaction for bundled services, packages and treatment plans to be completed within 90 days.* That way, patients can use promotional financing to help pay for chiropractic care over time, and your practice can get paid up front.

• Provide digital payment solutions. To help ensure a seamless payment experience, your practice can give chiropractic patients the option to pay through online patient portals or mobile-friendly payment solutions in the office, such as a scannable QR code. The CareCredit credit card is set up for a quick and easy digital application and payment process using a QR code or custom link.

5. Ensure regulatory compliance

Chiropractic practices must comply with relevant healthcare regulations to safeguard against potential legal issues and financial penalties.¹ Try these tips to help ensure compliance in your practice:

• Familiarize yourself with regulatory guidelines. Chiropractic regulations are continually evolving, so it’s crucial to be aware of all rules at the state and federal levels, including HIPAA and Medicare regulations. To stay up to date on the latest chiropractic billing practices and regulations, consider joining a professional chiropractic association, attending industry conferences or workshops or completing continuing education courses. This can help you stay aware of — and compliant with — any changes in coding guidelines, insurance policies and billing best practices.

• Conduct periodic audits. Regularly review your billing practices to help avoid compliance pitfalls such as unbundling codes, upcoding and reporting unlisted codes without documentation.¹⁰ Consider a two-pronged approach to these audits: internal and external reviews. Internal audits of your billing practices may help you identify and correct potential compliance issues, while external audits allow experts to assess your billing practices and recommend improvements.¹

6. Train your team for billing success

Be sure to conduct regular training sessions for your staff to help prevent errors and empower them to handle any billing and collection issues that may arise. Staff training may encompass:

• Best practices for patient financial communication
• Coding updates and guidelines to help prevent errors
• Insurance plans and coverage nuances, such as maximum allowed visits per year
• Payer-specific modifier guidelines to ensure staff are familiar with the latest updates

7. Leverage technology and outsourcing

If you want to boost efficiency in the billing process, consider investing in chiropractic billing software or outsourcing billing services. Software can automate aspects of the billing process, allowing your practice to easily create comprehensive patient records, submit and track claims and generate reports for financial analysis.¹ And dedicated billing professionals typically understand the complexities of chiropractic coding and compliance, which may result in clean claims and quicker reimbursement.³

8. Track key metrics and adjust strategies

Finally, it’s important to monitor significant financial metrics like claim rejection rates and days in accounts receivable. One healthy goal? Less than 30 days in accounts receivable.⁷ Consider using billing software to generate reports to analyze financial performance and identify trends, helping you make informed decisions.¹ Then, implement continuous improvement strategies to help optimize your practice’s revenue cycle management.

Optimizing Chiropractic Billing and Collection

Chiropractic billing may be a challenge, but it’s possible to navigate the process with confidence. By taking steps such as mastering coding and documentation, optimizing patient financial communication and offering flexible financing options, you can help enhance the accuracy of your billing, reduce the chance of claim denials and maximize reimbursements.¹

Offer Flexible Financing at Your Practice

If you are looking for a way to connect your patients or clients with flexible financing that empowers them to pay for the care they want and need, consider offering the CareCredit credit card as a financing solution. CareCredit allows cardholders to pay for out-of-pocket health and wellness expenses over time while helping enhance the payments process for your practice or business.

When you accept CareCredit, patients or clients can see if they prequalify with no impact to their credit score, and those who apply, if approved, can take advantage of special financing on qualifying purchases.* Additionally, you will be paid directly within two business days.

Learn more about the CareCredit credit card as a financing solution or start the provider enrollment process by filling out this form.

Author Bio

Robyn Tellefsen is a freelance writer and editor with more than 20 years of experience covering health and wellness, finance and more. Her work has appeared on sites such as LoopNet, Beachside Rehab, First Horizon Bank, SoFi, A Place for Mom, American Express, Chase and more.

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