[This post was originally published on 21st April 2023. It has been updated on 12th February 2026]
Navigate Modern Healthcare Billing Challenges with Confidence
As healthcare regulations continue to evolve in 2026, chiropractors face increasingly complex billing challenges. From updated Medicare guidelines to new telehealth billing codes, staying compliant while maximizing reimbursement requires constant attention. This comprehensive guide provides 15 essential chiropractic billing tips designed to help chiropractors navigate today’s healthcare landscape, reduce claim denials, and improve revenue cycle management.
1. Master Real-Time Eligibility Verification
Insurance coverage changes more frequently than ever, with patients switching plans mid-year and benefit structures updating quarterly. Real-time insurance eligibility verification is no longer optional, it’s essential for preventing claim denials and patient disputes.
Key Actions:
- Verify coverage before every appointment, not just initial visits
- Check for pre-authorization requirements, visit limits, and copayment amounts
- Confirm if chiropractic services are covered under the patient’s specific plan tier
- Document verification results in the patient record with date and time stamps
- Use automated eligibility verification tools integrated with your practice management software
The Medicare Beneficiary Eligibility Search can be accessed through the HETS system for real-time Medicare eligibility verification.
2. Stay Current with 2026 CPT and ICD-10 Code Updates
The American Medical Association updates CPT codes annually, and 2026 has introduced new codes for integrative care, remote therapeutic monitoring, and extended evaluation services. Using outdated codes results in immediate claim rejections and delayed payments.
Critical 2026 Updates:
- Review the latest CPT codes for chiropractic manipulation (98940-98943)
- Understand new codes for remote therapeutic monitoring of musculoskeletal conditions
- Update ICD-10 codes for subluxation complexes (M99.00-M99.09)
- Familiarize yourself with expanded telehealth CPT codes for virtual consultations
- Attend quarterly coding update webinars or subscribe to AMA CPT updates
Access the complete Medicare Physician Fee Schedule for current reimbursement rates and covered services.
3. Document Medical Necessity with Clinical Precision
Medical necessity documentation is the foundation of successful claim adjudication. Payers have started using advanced AI-driven claim review systems that flag insufficient documentation for manual review, leading to delays and denials.
Documentation Best Practices:
- Include specific clinical findings: range of motion measurements, findings, and postural assessments
- Document functional limitations and how they impact activities of daily living
- Clearly link the diagnosis to the treatment provided and expected outcomes
- Record objective measurements showing patient progress or regression
- Use SOAP note format consistently: Subjective, Objective, Assessment, Plan
- Document why chiropractic care is appropriate versus other treatment options
Example Documentation:
“Patient presents with acute lumbar pain (M54.5) following lifting injury 3 days ago. Objective findings: restricted lumbar flexion at 45° (normal 90°), positive orthopedic tests for facet syndrome, palpable muscle spasm L4-L5. Functional limitation: unable to sit >15 minutes without severe pain, affecting work as an accountant. Treatment: CMT lumbar spine (98941) with therapeutic exercises. Goal: restore 80% ROM within 4 weeks, return to full work duties.”
Medicare Reference: Review Medicare’s Documentation Guidelines for Evaluation and Management Services.
4. Master Modifier Usage to Prevent Automatic Denials
Modifiers communicate critical information about services rendered. Incorrect or missing modifiers trigger automatic claim denials, while proper modifier use can increase reimbursement for complex cases and multiple services rendered on the same date.
Essential Modifiers for Chiropractors:
- Modifier 25: Significant, separately identifiable E/M service on same day as CMT
- Modifier 59: Distinct procedural service (use when performing separate procedures)
- Modifier AT: Acute treatment (required by some payers for initial injury treatment)
- Modifier GP: Services delivered under physical therapy plan of care
- Modifier GY: Item/service statutorily excluded (use when service not covered)
Example:
A patient presents with new shoulder pain during a scheduled lumbar adjustment visit. The chiropractor performs:
- 99213-25 (E/M for shoulder evaluation – Modifier 25 indicates separately identifiable service)
- 98940 (CMT for original lumbar condition)
Without Modifier 25, the E/M service would be denied as bundled with the CMT.
Make sure to avoid these mistakes when using these modifiers with chiropractic codes. Read More.
5. Implement Strict Timely Filing Protocols
Timely filing deadlines vary by payer and can range from 30 days to 365 days from the date of service. Missing these deadlines results in permanent claim denial with no appeal option, representing lost revenue that can never be recovered.
Filing Deadline Management:
- Create a comprehensive payer filing limits reference chart for your practice
- Medicare: 365 days (calendar year) from date of service
- Medicare Advantage plans: Typically 90-180 days (verify with each plan)
- Commercial insurance: Ranges from 60-365 days
- Workers’ compensation: Varies by state, typically 30-90 days
- Set automated alerts in your practice management system 30 days before filing deadlines
- Submit claims within 7 days of service to build in buffer time for corrections
- Track claim submission dates and payer receipt confirmation
Medicare Reference: Medicare’s timely filing requirements are detailed in the Medicare Claims Processing Manual, Chapter 1, Section 70.
6. Optimize E/M Coding for Initial Consultations
Evaluation and Management (E/M) services for new patient consultations represent significant revenue opportunities that many chiropractors underutilize. The 2021 E/M coding changes (now well-established in 2026) emphasize medical decision-making complexity and time-based coding.
E/M Optimization Strategies:
- New patient office visits: 99202-99205 (based on medical decision-making or total time)
- Established patient visits: 99212-99215
- Document total time spent when time-based coding is advantageous
- Include all counselling, coordination of care, and review of diagnostic tests in time calculation
- For complex cases, document medical decision-making elements: number of diagnoses, data reviewed, risk level
- Use level 4 (99204/99214) appropriately—don’t default to lower levels when documentation supports higher complexity
Time-Based Coding Quick Reference (2026):
- 99202: 15-29 minutes
- 99203: 30-44 minutes
- 99204: 45-59 minutes
- 99205: 60-74 minutes
Medicare Reference: Review the E/M Services Guide for current coding guidelines.
[Read More: In-House Chiropractic Billing Or Outsource It – That’s A Million Dollar Question!]
7. Navigate Workers’ Compensation and Personal Injury Billing
Workers’ compensation and personal injury cases represent significant revenue opportunities but come with unique documentation requirements, state-specific regulations, and different billing protocols than traditional insurance. These cases often have higher reimbursement rates but require meticulous compliance to avoid payment delays or denials.
Workers’ Compensation Billing Requirements:
- Obtain claim number and authorization before treatment begins, many states require pre-authorization
- Document work-relatedness in every note: how injury occurred, date of injury, employer name
- Follow state fee schedules, workers’ comp has different rates than commercial insurance
- Submit initial injury reports within state-mandated timeframes (typically 24-72 hours)
- Provide detailed progress reports at required intervals (monthly or per visit thresholds)
- Document work restrictions and return-to-work status in every note
- Understand maximum medical improvement (MMI) determination requirements
- Bill using workers’ comp-specific codes when required (some states have unique code sets)
Personal Injury (Auto Accidents) Billing:
- Verify personal injury patient has active auto insurance or attorney representation before extensive treatment
- Document accident details: date, mechanism of injury, vehicle damage, police report number
- Obtain Letter of Protection (LOP) from attorney if billing on lien basis
- Use appropriate ICD-10 codes for injury mechanism (V-codes for vehicle accidents)
- Submit detailed narrative reports for attorney and insurance carrier
- Understand PIP (Personal Injury Protection) limits and billing sequence
- Bill at your standard fee schedule (not discounted rates) for PI cases
- Provide expert testimony preparation if case goes to litigation
Critical Documentation Elements:
- Causation statement linking injury to accident/work incident
- Objective findings on every visit (not just subjective complaints)
- Functional capacity evaluations showing work/activity limitations
- Treatment plan with estimated duration and expected outcomes
8. Develop a Systematic Denial Management Process
The average chiropractic practice experiences a 5-15% claim denial rate. The average chiropractic practice experiences a 5–15% claim denial rate. Without a structured denial management system, these denials often become write-offs. By following chiropractic billing best practices, you can reduce denials and recover 50–70% of initially denied claims.
Denial Management Framework:
- Review denial reasons within 24 hours of receipt
- Categorize denials: technical errors, medical necessity, authorization issues, timely filing
- Assign responsibility: front desk (eligibility errors), billing (coding errors), clinical (documentation)
- Track denial trends monthly, identify patterns indicating systemic issues
- Appeal promptly – most payers allow 60-180 days for first-level appeals
- Provide additional documentation proactively: clinical notes, treatment plans, research supporting medical necessity
- Consider peer-to-peer reviews for complex medical necessity denials
- Document all appeal submissions and responses
- Avoid claim denials pertaining to Excludes Notes for ICD-10 codes
Common Denial Reasons and Solutions:
- Services not medically necessary: Provide detailed clinical documentation showing objective findings and functional improvement
- Duplicate claim: Review claim submission records, provide proof of unique service date or distinguish from previous service
Authorization required: Implement pre-service authorization checks, maintain authorization tracking system
9. Leverage Technology with Integrated Practice Management Systems
Modern chiropractic billing requires integrated technology solutions. Manual processes increase error rates, slow cash flow, and consume staff time that could be dedicated to patient care. In 2026, AI-enhanced practice management systems offer real-time claim scrubbing, automated eligibility verification, and predictive analytics.
Technology Solutions to Implement:
- Electronic Health Records (EHR) with integrated billing modules
- Automated claim scrubbing to catch errors before submission
- Real-time eligibility verification APIs
- Electronic remittance advice (ERA) auto-posting
- Patient payment portals for online bill pay
- Automated appointment reminders to reduce no-shows
- Dashboard analytics showing key performance indicators: collection rate, days in A/R, denial rate
- AI-powered coding suggestions based on clinical documentation
ROI Considerations: Quality practice management software typically pays for itself through reduced claim denials (2-5% improvement), faster payment cycles (10-15 days faster), and decreased administrative overhead (20-30% staff time savings).
10. Master Medicare Coverage Policies and Local Coverage Determinations
Medicare coverage for chiropractic services is limited but specific. Understanding these limitations and Local Coverage Determinations (LCDs) is crucial for Medicare-accepting practices. The Manual Manipulation of the Spine policy determines what services Medicare will reimburse.
Medicare Coverage Essentials:
- Medicare covers manipulation of the spine to correct subluxation (98940-98943)
- Subluxation must be demonstrated by X-ray or physical examination
- Medicare does NOT cover: maintenance care, wellness visits, extremity adjustments, most therapies
- Documentation must demonstrate: subluxation exists, patient has neuromusculoskeletal condition, treatment addresses the subluxation
- X-rays are not required for every visit, but subluxation must be demonstrable
- Review your Medicare Administrative Contractor’s (MAC) Local Coverage Determination
- Understand frequency limitations and treatment duration expectations
Medicare Reference: Access the Manual Manipulation of the Spine Coverage Policy and search for “chiropractic” in the Medicare Coverage Database. Find your specific MAC’s LCD for regional requirements.
11. Establish Transparent Patient Financial Policies
Patient collections represent an increasing portion of practice revenue as high-deductible health plans become standard. Clear financial policies, communicated before treatment begins, significantly improve collection rates and reduce disputes.
Financial Policy Components:
- Provide good faith estimates for uninsured patients (required by federal No Surprises Act)
- Collect copayments, coinsurance, and deductibles at time of service
- Offer payment plans for balances exceeding patient’s immediate ability to pay
- Accept multiple payment methods: credit cards, HSA/FSA cards, digital wallets
- Provide written treatment plans with cost estimates for non-covered services
- Explain benefits verification results: what’s covered, patient responsibility, visit limits
- Implement automated billing statements sent within 7 days of service
- Train front desk staff on compassionate financial conversations
As of 2022 (ongoing in 2026), practices must provide good faith estimates to uninsured or self-pay patients. Visit the CMS No Surprises Act page for compliance requirements.
12. Conduct Regular Fee Schedule Analysis and Updates
Many practices operate with outdated fee schedules that fail to reflect current costs, market rates, or Medicare fee schedule changes. Annual fee schedule reviews ensure you’re not leaving money on the table or undervaluing services.
Fee Schedule Management:
- Review and update fee schedules annually, preferably in Q4 for January implementation
- Base fees on: geographic location, practice overhead, Medicare fee schedules, market surveys
- Monitor your area’s Medicare Physician Fee Schedule for annual adjustments
- Understand allowable amounts from contracted payers—your fee is irrelevant if below contracted rate
- Ensure cash pay rates are higher than or equal to highest contracted insurance rates
- Document rationale for fee increases (cost of living, new equipment, advanced certifications)
- Communicate fee changes to patients with 60-day notice for self-pay patients
It’s important to stay up-to-date on billing regulations to ensure that you are billing accurately and complying with regulations. You can attend training sessions or consult with chiropractic billing companies to stay up-to-date on billing regulations.
13. Monitor Key Performance Indicators (KPIs) Monthly
Data-driven practice management separates thriving practices from struggling ones. Monthly KPI monitoring identifies problems early, validates improvements, and guides strategic decisions about staffing, contracts, and service offerings.
Essential Billing KPIs:
- Days in Accounts Receivable (A/R): Target <30 days for optimal cash flow
- Net Collection Rate: (Payments ÷ Charges – Adjustments) × 100. Target >95%
- Gross Collection Rate: (Payments ÷ Charges) × 100. Benchmark varies by payer mix
- First-Pass Claim Acceptance Rate: Target >95% clean claim rate
- Denial Rate: Target <5% of submitted claims
- Point-of-Service Collections: Percentage of patient responsibility collected at visit
- Aged A/R Percentage: Track 0-30, 31-60, 61-90, 90+ day buckets. Target <20% over 60 days
- Write-off Percentage: Uncollectible amounts as percentage of total charges
Action Steps:
- Generate monthly reports from practice management software
- Compare to previous months and industry benchmarks
- Hold monthly billing meetings to review trends and identify improvement opportunities
- Set specific improvement goals with timelines and accountability
14. Ensure HIPAA Compliance in All Billing Operations
HIPAA violations carry severe penalties: $100-$50,000 per violation, with annual maximums reaching $1.5 million. Beyond financial consequences, breaches damage patient trust and practice reputation. In 2026, cybersecurity threats and electronic communication require heightened vigilance.
HIPAA Compliance Requirements:
- Implement administrative, physical, and technical safeguards for protected health information (PHI)
- Execute Business Associate Agreements (BAAs) with all vendors accessing PHI: billing companies, EHR vendors, clearinghouses, cloud storage providers
- Encrypt all electronic PHI in transit and at rest
- Train all staff annually on HIPAA requirements and practice policies
- Implement audit controls: track who accesses patient records and when
- Maintain secure disposal procedures for paper and electronic records
- Develop breach notification procedures (60-day notification requirement)
- Use secure email for patient communications (encrypted patient portals preferred)
- Limit access to PHI based on minimum necessary standard
- Conduct annual risk assessments to identify vulnerabilities
Common HIPAA Violations in Billing:
- Unencrypted email containing PHI
- Discussing patient information in public areas
- Improper disposal of billing documents
- Accessing records without legitimate need
- No BAA with billing service or clearinghouse
Reference: Review HIPAA requirements at the HHS HIPAA for Professionals page
15. Consider Strategic Outsourcing for Complex Billing Functions
As billing complexity increases and staffing challenges persist, many successful practices turn to proven billing tips for chiropractors, such as outsourcing billing functions to specialists. While not appropriate for every practice, outsourcing chiro billing can reduce administrative burden, improve collection rates, and allow in-house staff to focus on patient care and practice growth.
Outsourcing Decision Factors:
- Practice size: Outsourcing often makes sense for practices with <3 providers or >10 providers
- Current collection rate: If below 90%, professional billing may improve performance
- Staff expertise: High turnover or difficulty finding qualified billing staff indicates outsourcing may help
- Technology investment: Billing companies provide enterprise-level software you might not afford independently
- Compliance concerns: Managed chiropractic billing companies maintain dedicated compliance teams
What to Outsource:
- Full-service billing: claim submission, payment posting, denial management, patient billing
- Partial outsourcing: denial management only, credentialing, coding audits
- Specialized services: Medicare audits, workers’ comp billing, personal injury claims
Vendor Selection Criteria:
- Chiropractic-specific experience and knowledge
- Transparent pricing: percentage of collections (typically 5-10%) vs. flat fee
- Technology platform: cloud-based, real-time reporting, patient portal
- References from similar practices
- HIPAA compliance certification and BAA availability
- Performance guarantees and service level agreements
- Contract terms: avoid long-term commitments initially
- Dedicated account manager for your practice
Red Flags to Avoid:
- Promises of unrealistic collection rates (>98%)
- Lack of chiropractic-specific experience
- Poor communication or responsiveness during sales process
- Unwillingness to provide current client references
- Hidden fees beyond stated percentage
Conclusion
Effective billing management in 2026 requires a multifaceted approach combining technological solutions, rigorous processes, continuous education, and strategic decision-making. These 15 billing tips provide a comprehensive framework for optimizing revenue cycle management in your chiropractic practice.
Success in modern chiropractic billing requires:
- Proactive approach: Verify eligibility, document thoroughly, and submit claims promptly
- Continuous learning: Stay current with coding updates, payer policies, and regulatory changes
- Technology adoption: Leverage modern practice management systems and automation
- Data-driven decisions: Monitor KPIs and adjust strategies based on performance metrics
- Patient-centered policies: Transparent communication about costs and coverage
- Compliance focus: Maintain HIPAA standards and payer requirements
Remember: efficient billing isn’t just about maximizing revenue, it’s about ensuring your practice receives fair compensation for the valuable care you provide, allowing you to invest in better patient outcomes, practice growth, and your own professional development.
By implementing these 15 strategies systematically, you’ll build a sustainable billing foundation that supports your practice’s long-term success and allows you to focus on what matters most: delivering exceptional patient care.
Additional Medicare Resources
- Medicare Learning Network (MLN) – Educational resources and billing guides
- Medicare Administrative Contractors (MACs) – Find your regional contractor
- Medicare Coverage Database – Search coverage policies
- National Correct Coding Initiative (NCCI) – Code bundling and edit information
- Provider Enrollment, Chain, and Ownership System (PECOS) – Enrollment and credentialing
You May like to Read:
6 Effective Tips for Chiropractic Practices to Improve Billing and Claims Process
A Complete Guide to Chiropractic Billing and Coding
10 Questions You Should Ask Before Hiring Chiropractic Billing Services
5 Things to Consider When Selecting Chiropractor Billing Software