Running a chiropractic business involves a lot of responsibilities, such as seeing patients, documenting the visits, looking after your team, and making sure that your schedule is full. Although billing might not always be your highest priority, it does have a direct effect on the financial situation of your practice.
The difficult part is that billing problems generally do not all appear at the same time; one claim is rejected here, the insurance payment is delayed there, a patient balance is not collected, and a charge never gets turned into a claim. These problems might not appear to be very significant at first. Yet when they accumulate from month to month, they can result in thousands of dollars remaining in accounts receivable.
Which is why you should include a monthly chiropractic billing checklist to keep a check on your claims, posting, A/R, and revenue.
The chiropractic medical billing checklist below looks at the main areas that each chiropractic practice should examine on a monthly basis, together with the questions you should be asking in order to ensure that you are billing accurately, collecting consistently, and not leaving money on the table.
1. Check your Accounts Receivable (A/R)
If you want to get a quick idea of the financial condition of your practice, check your accounts receivable (A/R).
A/R represents the amount that your practice is still awaiting to be collected for services which you have already provided; this amount includes what is owed by insurance companies as well as the balances that patients owe.
What’s important isn’t just knowing the amount that is still owed; you also have to know how long that money has been outstanding. At the end of each month, review your A/R aging report and break outstanding balances into categories such as:
- Current: Recently billed and still within a normal payment window
- 30+ days: Balances that may need follow-up
- 60+ days: Claims or balances that shouldn’t be ignored
- 90+ days: Older A/R that requires active follow-up
- 120+ days: High-risk A/R where the chances of collecting may decrease
During your monthly A/R review, ask yourself:
- Is the total accounts receivable rising or falling?
- What portion of my accounts receivable are older than 30, 60, or 90 days?
- Does the majority of the unpaid amount come from insurance companies or from patients?
- Is it the case that some payers are taking longer to pay?
- Is there a situation where claims are not given follow-up?
- Are patient balances being consistently collected?
- Does the case exist of balances that are old and require a different method of collection?
The earlier you work out the reason, the better your chances of recovering what your practice has already earned.
2. Look over the claims you have about aging
After you’ve evaluated your entire A/R, the next thing in the chiropractic billing audit checklist your aging claims in more detail.
It doesn’t follow that every unpaid claim is a problem since insurance companies may take some time to deal with claims and it is possible that they are still within the ordinary payment period. The issue arises only when claims remain unresolved for weeks or months with no one acting on them.
At the close of every month, generate a report of your unpaid claims and check how long each one has been overdue. You can start by checking claims that are:
- Still being processed by the payer after about 30 days?
- Are not being paid yet and the reason for this.
Watch Your Timely Filing Limits
It is particularly important since insurance payers have time limits for filing claims. If the claim is not submitted or amended within the time frame that the payer has specified, you may lose the chance of being paid, even if the service was actually billable.
3. Review Claim Denials
Claim denials are a normal part of chiropractic medical billing, but repeated or unresolved denials can easily impact your practice revenue. If you’re only looking at how much was collected each month, you may not notice how much money is being delayed or lost because of denied claims.
In your chiropractic billing checklist, be sure to review your denial report to understand how many claims were denied, how much revenue was affected, and the reasons behind those denials. Here are the key denial-related billing metrics you should track:
| Billing Metric | Healthy Target | What It Means |
| Initial Denial Rate | < 5% | Fewer than 5 out of every 100 submitted claims are denied on the first submission |
| Clean Claim Rate | ≥ 95% | At least 95% of claims move through the initial submission process without requiring manual correction |
| Denial Resolution Time | < 30 days | Denied claims should be worked and resolved promptly rather than allowed to age |
| Denial Overturn Rate | > 60% | A strong appeal/rework process should successfully recover a significant share of appropriately appealable denials |
The <5% denial rate and ≥95% clean-claim rate are commonly used high-performance targets, while HFMA specifically recommends tracking denial rate, time to appeal, time to resolution, and overturn rate.
4. Look for Unbilled Services
A simple way for a chiropractic practice to see its revenue fall is to offer a service yet not bill for it. It doesn’t have to be due to anything complicated; the visit might not have been properly concluded, there might be a charge left in draft form, the SOAP note might still be incomplete, or a service might have been omitted when the claim was put together. When you’re busy seeing patients, it’s easy to miss these little gaps.
Check the SOAP notes and invoices in your chiropractic billing software to find:
- Completed visits with no charges attached
- Encounters still sitting in draft or pending status
- Unsigned or incomplete SOAP notes holding up billing
- Missing CPT or ICD-10 codes
- Missing modifiers or units
- Claims that failed before they were submitted
- Services documented in the patient record but not included on the claim
Your Objective for the month is to ensure that all completed and billable encounters are properly documented, coded, and submitted for payment without any unnecessary delays.
5. Review Coding Accuracy
Claim submissions can still result in denials, delayed payments, or improper reimbursement even if they are made on time; that is the reason why coding accuracy should be included in your monthly review of billing health.
When a chiropractic practice is dealing with claims, it should examine a few claims that have recently been submitted and check that the codes correctly represent the services given and those recorded in the patient’s file.
- Are the services being billed using the correct CPT codes?
- Do the diagnosis codes correspond to the services actually being provided?
- Did you use the required modifiers?
- Does the clinical documentation support the codes that have been billed?
- Are you adhering to the particular billing rules of insurance payers?
It isn’t necessary for you to go through each claim individually every month; instead, you should focus on services that are billed frequently, claims that are commonly denied, and any coding patterns that appear to be unusual.
6. Verify Insurance Eligibility and Benefits
A claim can be perfectly coded and submitted on time and still come back unpaid if the patient’s insurance coverage isn’t active. That’s why insurance eligibility should be checked before the visit.
Insurance information can change for various reasons, such as patients may switch employers, change plans, reach a deductible, lose coverage, or simply provide an outdated insurance card.
As part of your monthly billing health check, look for patterns in claims denied because of eligibility or coverage issues. Use automated insurance eligibility verification software to check for:
- Inactive or expired insurance coverage
- Incorrect member or policy numbers
- Changes in the patient’s insurance plan
- Missing or outdated insurance information
- Primary and secondary insurance issues
- Copay, deductible, and coinsurance changes
- Services that require authorization or referral
A monthly review can help you spot these patterns and tighten the front-end process.
7. Review Patient Balances
Insurance may pay part of a claim, but that doesn’t always mean the bill is fully settled. Copays, deductibles, coinsurance, and other patient responsibility can quickly add up.
That’s why your monthly chiropractic billing audit should include a close look at what patients still owe. You should start by reviewing:
- Outstanding patient balances
- Unpaid copays and deductibles
- Coinsurance balances
- Balances from older visits
- Failed payment plans
- Patient accounts with repeated unpaid balances
- Credits or overpayments that need to be resolved
The key is to look beyond the total amount owed. If patient A/R is steadily increasing each month, that’s a sign that your collection process may need attention.
You may need to make it easier for patients to pay at the time of service or provide convenient payment options such as online payments, text-to-pay, or card-on-file payments.
It’s also important to make sure patients understand what they are expected to pay. Clear communication about copays, deductibles, and outstanding balances can make collections much easier for both your team and your patients.
8. Review Insurance Payments and Underpayments
A claim being paid doesn’t always mean it was paid correctly.
Insurance payments should be reviewed each month to ensure the amount received matches what your practice expected based on the payer’s allowed amount and contract terms. Otherwise, underpayments can quietly become another source of revenue leakage.
For example, if an insurance payer consistently reimburses less than the contracted or expected amount for a service, you may continue accepting those payments without realising how much revenue you are missing over time.
So, what do you need to look into?
- Payments that are lower than expected
- Unexpected contractual adjustments
- Incorrect patient responsibility
- Services that were partially paid
- Claims that were paid but still show an outstanding balance
- Recurring underpayments from the same payer
- Significant changes in reimbursement patterns
- Highest-volume payers and most frequently billed services.
- Check the EOB or ERA, compare the payment with your contracted reimbursement
Tracking if your claims were paid is not enough. As a part of your monthly billing checklist, track if you were paid correctly and check recurring payment discrepancies before they become significant revenue losses.
9. Review ERA/EOB Posting Accuracy
One important step in a monthly billing checklist for chiro practices is making sure you’re posting payments correctly in your practice management system.
ERA (Electronic Remittance Advice) and EOB (Explanation of Benefits) statements show how an insurance company processed a claim, how much it paid, what was adjusted, what the patient owes, and whether any part of the claim was denied.
If those details aren’t posted correctly, your A/R reports can give you a misleading picture of your practice’s finances.
In your chiropractic billing checklist for ERA/EOB posting, add these points and track them:
- Insurance payments: Is the amount received matching the ERA/EOB?
- Patient responsibility: Are copays, deductibles, and coinsurance correctly assigned to the patient?
- Contractual adjustments: Are payer adjustments being recorded correctly rather than treated as outstanding revenue?
- Takebacks and recoupments: Are insurance reversals or payment takebacks reflected in the patient’s account?
- Unapplied payments: Are payments sitting in the system without being assigned to a specific claim or patient?
- Unmatched payments: Are there payments that haven’t been properly connected to the corresponding account?
10. Review Patient Credits and Refunds
When you’re reviewing your practice’s billing each month, don’t focus only on what patients and insurance companies still owe you. Take a look at the money sitting on the other side of the ledger too.
Patient credits and overpayments can happen for several reasons.
A patient may accidentally pay twice, an insurance company may pay more than expected, or a claim may be reprocessed after the patient has already paid their portion. If these credits aren’t reviewed regularly, they can quietly accumulate in patient accounts.
- Step 1: First determine why the credit exists
- Step 2: Whether it should be applied to another visit
This is also important for keeping your A/R accurate. A practice might appear to have healthy collections while carrying a growing amount of unresolved credits and overpayments.
How Chiropractic Billing Software Can Help
Keeping up with every part of your monthly billing checklist can be difficult when your team is relying on outdated software and multiple systems. This is where chiropractic billing software can make your monthly billing review much easier.
Instead of pulling information from different places, your team can use billing reports to get a clearer picture of claims, A/R, denials, payments, and outstanding balances.
Along with managing day-to-day practice operations, zHealth software brings billing, payments, and EHR data together so you can spend less time tracking down information and bill more accurately.
For example, if your monthly review shows that A/R is increasing, you can use zHealth’s billing and AI analytics tools to take a closer look at what’s driving the change. You can monitor claims and payments, review outstanding balances, and identify areas where your practice may be losing time or revenue.
Conclusion
A healthy chiropractic billing process isn’t something you check once a year.
For a chiropractic practice, small billing issues can quickly turn into aging A/R, denied claims, delayed payments, and lost revenue if they’re left unchecked.
When your practice has the right tools in place, a monthly billing check becomes less about manually searching for problems and more about quickly seeing what’s happening with your revenue and knowing what to do next.
Ready to simplify your billing workflow? Request a free demo of zHealth today.
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