Chiropractic billing in 2025 presents new challenges and opportunities for practices. With evolving insurance policies, coding updates, and the increasing shift toward digital healthcare solutions, chiropractors must stay informed to avoid claim denials and revenue loss. This bog provides a comprehensive approach to navigating these complexities and optimizing the billing process.
Understanding the Key Chiropractic Billing
1. Frequent Claim Denials and Rejections
Chiropractic clinics often struggle with claim denials and rejections, which can lead to cash flow disruptions and increased administrative workloads. The most common reasons for denials include coding errors, incomplete patient details, and insurance eligibility issues. Understanding these causes and implementing proactive solutions can significantly improve claim approval rates and streamline billing operations.
Common Reasons for Claim Denials and Rejections
I. Incorrect CPT or ICD-10 Codes
- Using outdated or incorrect Current Procedural Terminology (CPT) or International Classification of Diseases (ICD-10) codes results in claim denials.
- Chiropractic procedures require specific CPT codes (e.g., 98940-98942 for spinal manipulations) that must align with the patient’s diagnosis.
- Diagnosis codes (ICD-10) must support the medical necessity of the treatment. If a mismatch occurs, players may reject the claim.
Solution: Use chiropractic billing software that offers automated updates for codes and ensure coders are trained on the latest code changes.
II. Missing or Incorrect Modifiers
- Modifiers provide additional information about a procedure or service but, when used incorrectly or omitted, can lead to rejections.
- Chiropractic services often require modifiers like AT (Active Treatment) for Medicare claims to indicate medical necessity.
- Some insurers have specific requirements for modifiers, such as GP, GY, or 59, to differentiate services and avoid billing errors.
Solution: Ensure billing staff understand payer-specific modifier requirements and conduct periodic audits to identify and correct modifier mistakes.
III. Incomplete or Inaccurate Patient Information
Claims are frequently denied due to errors in basic patient details, such as:
- Misspelled names or incorrect dates of birth
- Invalid insurance policy numbers
- Outdated patient addresses
- Even small mistakes in patient data can cause unnecessary delays in reimbursements.
Solution: Implement chiropractic billing solutions with an integrated digital intake that enables patients to enter their details before the visit and all details are synced into the patient chart automatically.
IV. Eligibility Issues (Inactive Insurance, Lack of Coverage)
- Patients may unknowingly have inactive insurance policies or limited chiropractic coverage.
- Some insurers require pre-authorizations or have restrictions on the number of chiropractic visits per year.
- Denials may occur when a claim is submitted for services outside the patient’s coverage scope.
Solution: Perform real-time insurance eligibility verification before scheduling appointments. Train front-desk staff to check:
- Active insurance status
- Chiropractic service coverage limits
- Deductibles and co-pays
2. Insurance Policy Changes
Chiropractic billing mistakes are heavily influenced by frequent updates in Medicare, private insurance payers, and state-specific regulations. These changes can impact reimbursement rates, covered services, and documentation requirements. Failing to stay informed can lead to claim denials, compliance issues, and revenue loss.
Common Issues Due to Insurance Policy Changes:
- Medicare Reimbursement Updates: Changes in Medicare coverage for chiropractic adjustments, new coding requirements, or modifier rules (e.g., proper use of AT modifier for active treatment).
- Private Payer Policy Shifts: Private insurers may alter their policies regarding the number of covered visits, pre-authorization requirements, or telehealth reimbursement.
- State-Specific Regulations: Some states impose unique guidelines for chiropractic services, such as scope-of-practice changes or new Medicaid rules.
Solutions to Stay Updated & Avoid Issues:
- Regularly Review Payer Guidelines: Visit insurer websites and subscribe to updates on Medicare, Blue Cross Blue Shield, Cigna, Aetna, and UnitedHealthcare.
- Attend Industry Webinars & Conferences: Participate in chiropractic billing training sessions and payer-hosted events.
- Subscribe to Industry Newsletters: Follow ChiroCode, CMS updates, and chiropractic associations (ACA, ICA) for policy alerts.
- Consult with a Billing Expert: Have a dedicated chiropractic insurance billing consultant who can help you manage claims, AR claim denials, and insurance payments.
3. Slow Reimbursement & Cash Flow Issues
Delayed insurance reimbursements can severely impact a chiropractic clinic’s cash flow, making it difficult to cover operational expenses. Payment delays are often caused by claim errors, long processing times, or lack of follow-up on unpaid claims.
Common Causes of Slow Reimbursements:
- Claim Submission Errors: Incorrect CPT codes, missing information, or incorrect patient details.
- Manual Paper Claims: Submitting claims via paper instead of electronic processing leads to longer turnaround times.
- Lack of Follow-Up: Many clinics fail to track unpaid claims, leading to unnecessary payment delays.
Solutions for Faster Reimbursements:
- Implement Electronic Claim Submission (EDI): Use automated chiropractic billing software to submit claims electronically and reduce errors.
- Set Up Automated Follow-Ups: Use chiro billing software alerts to track unpaid claims and send automatic reminders to insurers.
- Outsource Billing if Necessary: If staff is overwhelmed, consider a chiropractic billing service to handle claim processing and denials.
- Offer Payment Plans for Patients: Provide automated payment options (e.g., credit card on file, online payments, recurring payments) to improve cash flow.
4. Complexities in Compliance and Documentation
Chiropractic care is subject to strict documentation and compliance requirements, especially for insurance claims. Insufficient documentation, improper SOAP notes, and failure to meet medical necessity criteria can result in claim denials, audits, and potential legal issues.
Common Documentation & Compliance Challenges:
- Inadequate SOAP Notes: Failing to document subjective, objective, assessment, and plan details accurately.
- Lack of Medical Necessity Justification: Insurers require detailed justification for each visit, including treatment goals and patient progress.
- Failure to Follow Compliance Regulations: Medicare, HIPAA, and payer-specific requirements for record-keeping and data security.
Solutions for Better Documentation & Compliance:
- Train Staff on Proper Documentation: Regular training on SOAP note standards, payer expectations, and compliance requirements.
- Use Structured EHR Templates: Chiropractic insurance billing software with pre-built SOAP note templates ensures consistency and accuracy.
- Audit Documentation Regularly: Conduct internal audits or hire compliance experts to review documentation and prevent errors.
- Follow Medicare’s Compliance Guidelines: Understand Medicare’s Local Coverage Determinations (LCDs) for chiropractic care.
5. Patients’ High Out-of-Pocket Costs
One of the biggest chiropractic billing challenges is patients struggling with high out-of-pocket costs, which can lead to non-payment, reduced visits, and lower patient retention. Patients often feel blindsided by unexpected bills, leading to dissatisfaction.
Common Issues Related to High Patient Costs:
- Unexpected Bills: Patients are unaware of coverage limitations, deductibles, and co-pays until they receive a bill.
- Lack of Payment Flexibility: Some patients cannot afford to pay the full amount upfront, leading to unpaid balances.
- Insurance Coverage Gaps: Some insurance plans cover only a limited number of chiropractic visits, leaving patients to pay the rest.
Solutions for Managing Patient Costs & Improving Collections:
- Provide Clear Cost Estimates Upfront: Explain treatment costs before starting care, including expected insurance coverage and patient responsibility.
- Offer Flexible Payment Plans: Set up monthly payment options, auto-draft payments, and financing plans for high-cost treatments.
- Use Transparent Billing Statements: Ensure patient invoices are clear, itemized, and easy to understand.
- Educate Patients on Their Insurance Benefits: Help patients understand their deductibles, co-pays, and out-of-pocket limits to avoid confusion.
6. Optimizing Chiropractic Billing Workflow
a. Accurate CPT and ICD-10 Coding
Using the correct CPT and ICD-10 codes is essential for getting paid accurately and on time. For chiropractic manipulative treatment (CMT), always use the correct CPT codes:
- 98940 – 1-2 spinal regions
- 98941 – 3-4 spinal regions
- 98942 – 5 spinal regions
- 98943 – one or more of the extra-spinal regions (head region; lower extremities; upper extremities; rib cage; abdomen)
Ensure diagnosis codes (ICD-10) match the treatment provided to avoid claim denials. Regularly update coding practices based on the latest payer guidelines and Medicare updates.
b. Effective Use of Modifiers
Modifiers are essential for clarifying the purpose of treatment and ensuring proper reimbursement. For Medicare claims, use the AT modifier (Active Treatment) to indicate medically necessary care. Other commonly used modifiers include:
- GP – Services under a physical therapy plan
- GA – Waiver of liability on file
- GY – Non-covered service
- GZ – Service expected to be denied as not reasonable or necessary
Understanding payer-specific modifier rules can prevent unnecessary denials and improve claims approval rates.
7. Streamlining Insurance Verification
Insurance verification mistakes can lead to claim rejections and unpaid services. Using automated eligibility verification tools helps check coverage in real time, reducing errors. Maintain a database of payer-specific rules so your staff can confirm requirements before a patient’s visit. This ensures you know what’s covered, patient co-pays, and potential limitations before providing treatment.
a. Improving Claims Submission Process
Submitting claims electronically through a secure clearinghouse ensures faster processing and fewer errors. Manual claims often lead to delays and rejections due to incomplete information. Set up automated alerts for rejections and denials so your team can fix and resubmit claims quickly, reducing cash flow disruptions.
b. Implementing a Robust Accounts Receivable (A/R) Strategy
To maintain a healthy cash flow, monitor outstanding claims regularly and take action on unpaid accounts. A structured follow-up system ensures claims don’t get stuck in processing delays. Set clear policies for reminders, appeals, and patient payment follow-ups to reduce bad debt and increase revenue.
By optimizing your chiropractic billing workflow, you can reduce claim denials, speed up reimbursements, and improve overall financial stability in your practice
8. Leveraging Technology for Billing Success
Managing chiropractic billing challenges can be overwhelming, especially when dealing with insurance claim denials and rejections. A well-integrated EHR and chiropractic insurance billing system can help streamline the entire process, reducing manual errors, improving claim approvals, and boosting revenue collection.
Here’s how an integrated chiropractic EHR and billing software can transform your practice:
Benefits of an Integrated Chiropractic EHR & Billing System
a. Reduces Manual Errors
Billing errors are one of the most common reasons for claim denials and delayed payments. With an EHR and billing system, chiropractic practices can:
- Auto-populate CPT codes and ICD-10 diagnosis codes, reducing the risk of human errors.
- Ensure SOAP notes and treatment documentation match billing claims.
- Conduct real-time eligibility checks to verify insurance coverage before treatment.
- Integrate automated compliance checks to prevent rejected claims.
b. Automated Payment Solutions
Digital payment options are becoming a necessity for chiropractic practices to improve collections and patient satisfaction. An integrated billing system offers:
- Text-to-Pay & Email-to-Pay: Allows patients to pay their bills easily via text or email, reducing outstanding balances.
- Surcharges Feature: Helps clinics pass processing fees to patients, reducing merchant processing costs while maintaining convenient payment options.
With automated payment solutions, chiropractors can minimize late payments and ensure a steady cash flow without relying on manual collection efforts.
c. Reporting & Analytics for Better Revenue Insights
Tracking billing performance is crucial to improving revenue and reducing chiropractic billing mistakes. A billing software for chiropractors provides:
- Custom reports to analyze revenue trends, outstanding claims, and payment cycles.
- Insights into claim denials, helping adjust billing strategies to minimize rejections.
- Automated alerts for unpaid claims, ensuring timely follow-ups.
[Read More: 5 Things To Consider When Selecting Chiropractor Billing Software]
9. Outsourcing Chiropractic Billing: Is It the Right Choice?
If your clinic is struggling with high denial rates, inconsistent cash flow, or overwhelming administrative tasks, outsourcing chiropractic insurance billing might be the right solution.
By partnering with an experienced billing service company, practices can reduce errors, speed up reimbursements, and focus on patient care instead of paperwork.
zHealth’s Chiropractic Billing Services offer a comprehensive solution tailored for chiropractic clinics. Our expert team ensures accurate claim submissions, real-time eligibility checks, denial management, and automated payment processing.
With transparent reporting and compliance checks, zHealth helps chiropractors maximize revenue while minimizing administrative burdens.
Conclusion
Navigating chiropractic billing challenges in 2025 requires staying updated with coding changes, leveraging technology, and maintaining compliance. By implementing best practices and optimizing billing workflows, chiropractors can minimize denials, enhance revenue, and focus on patient care. Whether managing billing in-house or outsourcing, the key is to stay proactive and adaptable to industry trends.
Want to see how zHealth’s billing specialists can help you?
Related articles:
Complete Guide To Chiropractic Medical Billing & Coding 2025
Key Financial Metrics For A Successful Chiropractic Practice
ICD-10 Update 2025: Key Changes To Improve Billing Accuracy
Know The Top Chiropractic CPT Codes That Can Save Your Billing Time
