[This post was originally published on 7th September 2021. It has been updated on 15th January 2025.]
Managing chiropractic billing effectively is key to improving revenue and ensuring the financial health of your practice. Chiropractic medical billing is complex due to frequent changes in codes, insurance policies, and compliance requirements.
According to a recent survey by ChiroEco, average gross billings for chiropractors reached $716K in 2024. Collections also saw an increase, rising from $489K in 2023 to $506K in 2024. These statistics highlight the importance of effective billing strategies to maintain and grow revenue.
Adopting the right strategies can help you streamline your billing workflow, reduce claim denials, and boost monthly revenue. Here are five chiropractic billing strategies to improve your chiropractic billing process:
1. Establish an Insurance Verification Procedure
Insurance verification is the first and most crucial step in the billing process. It ensures that you have accurate information about a patient’s insurance coverage, reducing the risk of claim denials.
Steps to establish a verification procedure:
- Check Prior Authorization Requirements: Some insurance companies mandate prior authorization for specific chiropractic treatments. Confirm if authorization is needed before rendering services.
- Verify Coverage for the Date of Service (DOS): Insurance coverage may change unexpectedly. Ensure the patient’s insurance plan is active on the DOS.
- Confirm Covered Services: Determine whether the patient’s insurance plan includes the chiropractic services you provide. For non-covered services, inform the patient of potential out-of-pocket costs upfront.
- Monitor Visit Limits: Some plans limit the number of chiropractic visits or the total amount reimbursable in a given period. Check how many visits are remaining and notify the patient if they’re nearing the maximum limit.
Proper insurance verification reduces errors, prevents denials, and improves patient satisfaction.
2. Ensure Proper Documentation Using EHR Software
Accurate and thorough documentation is essential for successful chiropractic billing. Errors such as insufficient documentation, lack of medical necessity, or incomplete SOAP notes can lead to claim rejections. Chiropractor software has an Integrated SOAP notes tool that offers a library of SOAP templates and SOAP notes builder. These features enable providers to choose templates that suit their treatment style or create their own SOAP template.
Benefits of using chiropractic software for documentation:
- Improved Accuracy and Legibility: Digital SOAP notes simplify documenting patient visits, ensuring clarity and compliance with insurance requirements.
- Streamlined Workflow: Customized SOAP templates make it easy to record subjective (patient complaints), objective (exam findings), assessment (diagnosis), and plan (treatment) details.
- Audit Readiness: Comprehensive documentation supports post-payment audits and reduces the risk of penalties.
- HIPAA Compliance: Chiropractic software systems safeguard patient data, ensuring compliance with legal and ethical standards.
Investing in a chiropractic software system like zHealth can streamline your documentation process, save time, and ensure you receive proper reimbursements.
3. Ensure Correct Coding Using Chiropractor Billing Software
Accurate coding is fundamental to ensuring clean claims and timely reimbursements as part of effective chiropractic billing strategies.
However, keeping up with frequent updates to CPT codes and ICD-10 codes can be challenging. Chiropractic billing software can simplify this process by auto-populating codes and ensuring you use the latest revisions.
How billing software simplifies coding:
- Auto-Populated Codes: Advanced software allows you to type in partial diagnoses or procedures, automatically suggesting the correct codes.
- Updated Code Libraries: Chiropractor billing software is regularly updated with the latest coding changes to ensure compliance.
- Error Reduction: Automated coding minimizes the likelihood of mistakes that could lead to claim denials.
- Claim Scrubbing: Claim scrubbing is an essential feature of chiropractic billing software. It automatically reviews claims for errors or inconsistencies before submission, ensuring they meet payer guidelines. This minimizes denials and helps secure faster reimbursements.
- ERA Auto-Posting: With ERA auto-posting, chiropractic billing software automatically posts payment details from insurance companies to patient accounts. This reduces manual work, ensures accurate payment tracking, and streamlines the revenue cycle process.
Efficient Claims Submission: Chiropractor billing software supports electronic claims submission, saving time and reducing errors compared to paper forms.
4. Evaluate Accounts Receivable (A/R) Regularly
Accounts receivable (A/R) management is a critical aspect of maintaining a healthy cash flow. The longer payments are delayed, the harder they become to collect. Effective A/R management strategies can help optimize your revenue cycle and maintain financial stability.
Strategies for A/R Management:
1. Submit Claims on Time: File claims promptly, ideally on the same day the service is provided. Timely submissions reduce delays and ensure quicker reimbursements.
2. Segment Receivables: Separate patient balances from insurance receivables. This makes tracking and following up on payments easier and more efficient.
3. Review Payer Patterns: Regularly analyze insurance company payment patterns to identify delays, discrepancies, or trends. This helps you address issues proactively and improve cash flow.
4. Monitor A/R Days: Aim to keep your A/R days within 0 to 30 days. Longer A/R days indicate delays in payment collection, which can affect your practice’s financial health.
5. Follow-Up on Denied Claims: Address denials immediately by reviewing and resubmitting corrected claims. Timely follow-ups improve the likelihood of payment and reduce revenue losses.
Frequent Evaluations: Conducting regular A/R evaluations helps you identify bottlenecks, address issues promptly, and optimize your overall revenue cycle.
5. Outsource Chiropractic Billing Services
Outsourcing billing tasks can significantly reduce administrative burden and improve revenue cycle management. Chiropractic billing services are handled by experts who specialize in medical billing for chiropractors, including coding, claim submissions, and payment follow-ups, and AR management.
Benefits of outsourcing billing services:
- Expertise: Billing professionals stay updated on coding and insurance changes, reducing errors and improving claim approval rates.
- Time Savings: Free up time to focus on patient care and other core activities.
- Better Cash Flow: Professional billers follow up on denied or unpaid claims, ensuring faster reimbursements.
- Transparency: Regular billing reports provide insights into your practice’s financial health.
Partnering with a reliable chiropractic billing service like zHealth ensures accuracy, efficiency, and improved revenue performance.
Bonus Tip:
Stay on Top of Modifier Usage
Properly using chiropractic CPT modifiers in your billing can prevent claim denials and ensure you’re reimbursed for all services rendered.
Make sure you’re familiar with common modifiers like -25 (significant, separately identifiable evaluation and management service) or -59 (distinct procedural service) and when to apply them.
Incorrect modifier usage or missing them entirely can result in delays or non-payment. Regularly review payer guidelines to ensure your modifier application aligns with insurance requirements, helping you avoid costly mistakes and ensuring smoother reimbursements.
[Read More: Mistakes to Avoid When Using These Modifiers with Chiropractic Codes]
Conclusion
Chiropractic medical billing is complex, but implementing these strategies can simplify your workflow and boost your monthly revenue. From verifying insurance to using advanced EHR and billing software, and outsourcing billing services, these chiro billing strategies ensure you get paid faster and more accurately. By focusing on efficient billing, your practice can thrive financially while allowing you to prioritize patient care.
If you’re ready to streamline your billing and revenue cycle, contact zHealth today to learn how our solutions can support your chiropractic practice.
Related Articles:
Know the Top Chiropractic CPT Codes That Can Save Your Billing Time
Top 8 Free Resources to Streamline Chiropractic Medical Billing
