Running a chiropractic practice means wearing two hats, clinician and business owner. Most DCs are exceptional at first. Chiropractic revenue cycle management (RCM) is where money quietly slips through the cracks.
The average chiropractic practice loses 10-15% of its potential revenue to billing errors, claim denials, and slow collections. That’s not a clinical problem, it’s a process problem. And process problems have solutions.
This blog breaks down 10 actionable chiropractic RCM strategies that help chiropractic practices get paid faster, reduce claim denials, and stop leaving revenue on the table.
What Is Revenue Cycle Management and Why Does It Matter for Chiropractors?
Chiropractic revenue cycle management is the full financial process that begins the moment a patient books an appointment and ends when every dollar owed has been collected. It covers eligibility verification, coding, claim submission, payment posting, denial management, and patient collections.
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10–15% Revenue lost to billing errors |
< 5% Target denial rate |
< 30 days Target days in AR |
> 95% Target clean claim rate |
For chiropractic practices, RCM carries unique challenges. Chiro claims are frequently flagged for medical necessity. Insurance companies often require detailed documentation for spinal manipulation codes. Coverage limits vary wildly between plans. And patients increasingly owe more out of pocket, making collections a critical, and often uncomfortable, part of practice management.
At a Glance: 10 Chiropractic RCM Tips
| # | TIP | WHEN TO ACT |
| 01 | Verify Insurance Eligibility | Before every visit |
| 02 | Collect at Time of Service | Day of appointment |
| 03 | Get Chiropractic Coding Right | Ongoing |
| 04 | Write Documentation That Justifies Billing | Every visit |
| 05 | Submit Claims Daily | End of each day |
| 06 | Track & Work Your Denials | Within 30 days |
| 07 | Pre-Authorize When Required | Before treatment |
| 08 | Reduce Patient Payment Friction | Ongoing |
| 09 | Monitor Key Metrics Weekly | Every week |
| 10 | Invest in Right Tech or People | Now |
Tip 1: Verify Insurance Eligibility Before Every Single Visit
This sounds basic because it is, and yet it’s the single most common source of avoidable claim denials in chiropractic practices.
Patient coverage changes constantly. Employers switch carriers. Annual deductibles reset in January. Patients hit their chiropractic visit limits. A policy that was valid last Tuesday may not be valid today.
What to do: Implement automated software that verifies patient insurance eligibility at least 24-48 hours before each appointment, not at the front desk while the patient is standing in front of you. Use your practice management software’s automated eligibility checking if available. For new patients, verify on the day they book.
When verifying, confirm not just that the patient has coverage, but the specific chiropractic benefit: visit limits, remaining visits for the year, deductible status, copay or coinsurance amounts, and whether a referral or pre-authorization is required.
Document every verification with a timestamp. If a claim is later denied due to eligibility issues, that documentation protects you.
Tip 2: Collect Patient Financial Responsibility at Time of Service, Every Time
One of the fastest ways to improve cash flow is to stop billing patients after the fact for amounts they owed at the time of service.
Post-visit patient billing is slow, expensive, and increasingly ineffective. Studies show that the likelihood of collecting a patient balance drops significantly once they leave the office. After 90 days, many of those balances become effectively uncollectable without a collections agency.
What to do: Know the patient’s financial responsibility before they arrive. When you’ve verified eligibility, calculate their copay, coinsurance, or estimated deductible portion and communicate it to them in advance, ideally when they confirm the appointment. Make it easy to pay at checkout with card on file, digital payment links, or in-app payment tools.
Train your front desk staff to collect payment as a standard part of checkout, not an awkward afterthought. A simple script helps: “Your portion for today’s visit is $X, would you like to put that on the card we have on file?”
Tip 3: Get Your Chiropractic Coding Right the First Time
Incorrect or imprecise coding is one of the top drivers of claim denials and underpayments in chiropractic billing. The difference between a clean claim and a denied one often comes down to a single modifier or a mismatched diagnosis code.
The codes that matter most for chiropractors:
The spinal manipulation codes (98940, 98941, 98942) are differentiated by the number of spinal regions treated, not by time or complexity. Using 98941 when you treated only one region, or failing to document the regions treated, invites denial.
ICD-10 diagnosis codes must support medical necessity. Vague codes like M54.5 (low back pain) are increasingly scrutinized. Specificity matters, laterality, chronicity, and causation all strengthen your claim.
Modifier 59 (distinct procedural service) and AT modifier (active/corrective treatment, required by Medicare) are frequently misapplied or omitted, causing significant downstream problems.
Chiropractic Coding Quick Reference
| CODE / MODIFIER | DESCRIPTION | KEY NOTE |
| 98940 | Spinal manipulation, 1–2 regions | Low back, single region — most common |
| 98941 | Spinal manipulation, 3–4 regions | Must document each region clearly |
| 98942 | Spinal manipulation, 5 regions | All regions — requires thorough notes |
| 98943 | Extraspinal manipulation | Extremity adjustments |
| 97110 | Therapeutic exercise | Attach to supervised rehab |
| 97035 | Ultrasound therapy | Document time and area |
| 99213 | E&M established patient (moderate) | Separate from manipulation |
| AT Mod | Active/corrective treatment | REQUIRED for all Medicare chiro claims |
| Mod 59 | Distinct procedural service | When billing manipulation + therapy same day |
What to do: Conduct a coding audit of your denied claims. Look for patterns, if the same code combination is being denied repeatedly, that’s a systemic issue, not a one-off. Invest in coder training or work with a chiropractic billing specialist who knows the nuances of spinal manipulation coding.
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Common Coding Mistakes Using 98941 when only one spinal region was treated. Omitting the AT modifier on Medicare claims. Vague ICD-10 codes like M54.5 (low back pain) without specificity. Missing Modifier 59 when billing manipulation and therapy on the same day. |
Tip 4: Write Documentation That Justifies Your Billing, Before You Bill
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Insurance companies don’t deny claims because they doubt your clinical judgment. They deny them because your documentation doesn’t support the codes you submitted.
Medical necessity is everything in chiropractic billing. Your notes need to tell a clear story: what’s wrong with the patient, why chiropractic care is the appropriate treatment, what you did during the visit, and what progress (or lack thereof) justifies continued treatment.
What to do: Use SOAP notes consistently and completely. Your subjective section should capture the patient’s reported symptoms, pain level, and functional limitations. Your objective section needs measurable findings, range of motion, orthopedic test results, neurological findings. Your assessment must connect those findings to a specific diagnosis. Your plan should justify the next visit.
If you’re using templated notes in your EHR, audit them regularly. Cookie-cutter notes that look identical across 40 visits are a red flag for payers and auditors. Notes should reflect what actually happened that day.
If you’re using templated notes in your EHR, audit them regularly. Cookie-cutter notes that look identical across 40 visits are a red flag for payers and auditors. Notes should reflect what actually happened that day.
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SOAP Note Checklist Subjective: Patient’s reported symptoms, pain level (0–10), functional limitations. Objective: Measurable findings – ROM, orthopedic tests, neurological findings. Assessment: Clear diagnosis code connected to objective findings. Plan: Specific treatment rationale that justifies the next visit. Audit your templated notes regularly. Cookie-cutter notes that look identical across 40 visits are a red flag for payers and auditors. |
Tip 5: Submit Claims Daily, Not Weekly, Not “When You Get Around to It”
Every day between service delivery and claim submission is a day you’re not getting paid. Many practices batch their billing weekly, losing 5–7 days of revenue velocity per claim cycle for no good reason.
What to do: Make daily claim submission a non-negotiable part of your billing workflow. Most modern practice management systems can automate this, claims for services rendered today go out today. Same-day or next-day submission is the standard for high-performing practices.
Also, know your payer’s timely filing limits. Most commercial insurers require claims within 90–180 days of the date of service. Medicare requires 12 months. Missing these windows means writing off revenue that was legitimately earned, with no appeal process available.
Tip 6: Track and Work Your Denials, Don’t Just Write Them Off
The average chiropractic practice writes off a significant portion of denied claims without ever appealing them. This is one of the most expensive habits in practice management.
Most claim denials are appealable. Many are overturnable. And the patterns in your denials are telling you exactly where the chiropractic practice revenue cycle has holes.
What to do: Categorize every denial by reason code. CO-4 (incorrect code), CO-11 (diagnosis inconsistent with procedure), CO-97 (duplicate claim), PR-204 (not covered), each code points to a different root cause and requires a different fix.
Set a denial management KPI for your practice: your denial rate should be under 5%, and your denial overturn rate should be above 50%. If you’re not tracking these numbers, you don’t know how much you’re losing.
Build a 30-day denial follow-up workflow. Any denied claim that hasn’t been resubmitted or appealed within 30 days should trigger an alert. Letting denials age is letting money disappear.
Common Denial Reason Codes & How to Respond
| CODE | WHAT IT MEANS | WHAT TO DO |
| CO-4 | Incorrect procedure code | Verify code against payer guidelines & resubmit |
| CO-11 | Diagnosis inconsistent with procedure | Add supporting ICD-10 code; improve specificity |
| CO-97 | Service included in another paid service | Check bundling rules; use modifier 59 if applicable |
| CO-16 | Missing or invalid information | Review claim for missing fields; resubmit complete claim |
| PR-204 | Not covered by plan | Collect from patient; file patient responsibility |
| CO-22 | Prior authorization missing | Submit auth retroactively if possible or write off |
| CO-29 | Timely filing limit exceeded | Document proof of timely submission and appeal |
| CO-96 | Non-covered charge | Verify benefits; adjust or collect from patient |
Tip 7: Pre-Authorize When Required, and Track Your Auth Expiration Dates
Prior authorizations are increasingly common for chiropractic care, particularly for extended treatment plans, MRI referrals, and certain payer contracts. Treating without a required authorization almost always results in a denial that cannot be appealed.
Even when you have an auth, losing track of the expiration date or approved visit count is a costly mistake.
What to do: Know exactly which payers in your network require prior authorization for chiropractic services, and for what circumstances. Build an authorization tracking system, even a simple spreadsheet beats nothing, that captures the auth number, approved visit count, covered date range, and an alert for when you’re approaching the limit.
When a patient is approaching their authorized visit limit and still needs care, initiate the re-authorization process early, before you hit the wall. Last-minute auth requests are frequently delayed, leaving you treating without coverage or turning away a patient mid-plan.
RCM Benchmark Scorecard
| METRIC | EXCELLENT | ACCEPTABLE | NEEDS WORK |
| Days in AR | Under 30 days | 30–45 days | Over 45 days |
| Denial Rate | Under 5% | 5–10% | Over 10% |
| Clean Claim Rate | Above 95% | 88–95% | Below 88% |
| Net Collection Rate | Above 97% | 93–97% | Below 93% |
| AR Over 90 Days | Under 10% | 10–20% | Over 20% |
| Denial Overturn Rate | Above 60% | 40–60% | Below 40% |
Tip 8: Reduce Friction in the Patient Payment Experience
Patients don’t refuse to pay because they’re dishonest. They delay paying because paying is inconvenient, confusing, or surprising. Your job is to remove every one of those barriers.
What to do: Send clear, itemized statements that explain what was billed, what insurance paid, and what the patient owes, in plain language, not billing jargon. Offer multiple payment options: credit/debit cards, HSA/FSA cards, payment plans for larger balances, and digital payment links via text or email.
Store cards on file (with patient consent) for frictionless checkout. Offer autopay for patients on recurring care plans. Send payment reminders by text rather than waiting for a paper statement to arrive 10 days later.
The easier you make it to pay, the faster you get paid. That’s not a sales tactic, it’s a service.
Tip 9: Monitor Your Key Revenue Cycle Metrics Weekly
You can’t improve what you don’t measure. Many chiropractic practices run their revenue cycle on instinct and hope. High-performing practices run it on data.
The metrics every chiro practice should track:
- Days in Accounts Receivable (AR): How long, on average, does it take to collect payment after a service is rendered? Under 30 days is excellent. Over 45 days signals a problem somewhere in the chiropractic practice revenue cycle.
- Denial Rate: What percentage of your submitted claims are denied on first submission? Industry benchmark is under 5%.
- Clean Claim Rate: What percentage of your claims pass through without any corrections or resubmissions? Aim for above 95%.
- Collection Rate: What percentage of your adjusted charges are you actually collecting? Net collection rate below 95% means revenue is leaking.
- AR Aging: How much of your outstanding AR is over 90 days? Over 120 days? Aging AR is increasingly uncollectable AR.
Review these numbers weekly, not quarterly. Trends emerge quickly, and early intervention costs far less than late cleanup.
Tip 10: Invest in the Right Technology, or the Right People
Manual billing processes are expensive, error-prone, and slow. Every claim that requires a human to touch it multiple times is a claim that costs you more to collect than it should.
Modern chiropractic practice management software can automate eligibility verification, flag coding errors before submission, track authorization limits, generate denial worklists, and give you real-time visibility into your AR. These aren’t luxuries, they’re the infrastructure of a financially healthy practice.
What to do: Evaluate your current billing software against what’s available. If your system can’t check eligibility automatically, submit claims electronically, or give you an AR aging report with a few clicks, it’s costing you money every month.
If technology isn’t the issue but bandwidth is, consider outsourcing your billing to a chiropractic-specialized billing company. The cost (typically 6–9% of collections) is almost always offset by improved collection rates and fewer write-offs. The key is “chiropractic-specialized”, general medical billers often don’t know the nuances of spinal manipulation coding and payer-specific chiro rules.
Also Read: 5 Ultimate Tools in Chiropractic Software that Can Increase Your Monthly Revenue
Conclusion
Chiropractic revenue cycle management isn’t glamorous. It doesn’t directly help patients feel better or build your clinical reputation. But it is what keeps your practice financially viable, which means it’s what keeps you in a position to help patients at all.
The practices that get paid fastest aren’t necessarily the ones with the best clinical outcomes or the busiest schedules. They’re the ones with clean, consistent billing processes, staff who know what they’re doing, and the data to catch problems early.
That’s where the right tools make all the difference. An integrated platform like zHealth’s all-in-one practice management software brings scheduling, documentation, billing, clearinghouse integration, AR tracking, and performance reporting into one connected workflow. And for clinics that prefer hands-off support, professional billing services can further reduce denials, speed up reimbursements, and protect cash flow.
Related articles:
Boost Your Practice’s Revenue with Chiropractic Practice Management Software
4 Expert Tips to Grow the Revenue of Your Chiropractic Practice
Cash vs. Insurance Billing Models: What Works Better for Chiropractors?
Best Practices to Improve Chiropractic Billing Accuracy and Cash Flow
