How to Avoid Common Chiropractic Billing Mistakes

Are you confused, or quite possibly overwhelmed, by all there is to know about chiropractic billing? If your answer is yes, you’re not alone.

This is what I hear all of the time: There was little focus on chiropractic billing in chiropractic school. A cash- based practice was presented as the better option over an insurance-based practice because you don’t have to “jump through all of the hoops.”  

Here is where I see so many chiropractors get it wrong-the assumption that “jumping through hoops” implies that a series of difficult things need to be done only when billing insurance. When, in fact, a series of things need to be done regardless of whether you bill insurance or have a cash-based practice.

Why? Because there are guidelines. And the guidelines are the guidelines…. regardless of whether you have an insurance-based practice or a cash-based practice.   

So, let’s break it down.  

Understanding Chiropractic Billing Guidelines

What if your dream had been to open a restaurant instead of becoming a chiropractor?

You begin strategizing your new restaurant by outlining your menu and laying out your kitchen design and flow. You feel confident in your plan and what you have put together.

However, after researching food service guidelines you realize that cross contamination guidelines dictate where items can be placed changing your entire kitchen design and flow. You also learn that food storage guidelines change what you presumed would be offered on your menu.

These restaurant guidelines apply regardless of which customer is paying and by what means they choose to pay.

The same holds true in your chiropractic practice. The means by which you are paid for the services you provide does not change the guidelines that must be followed.  

Learn the guidelines first, then set up your chiropractic billing practices around the guidelines.

Chiropractic Billing Guidelines: Medicare and Medicaid Explained

Medicare and Medicaid guidelines play a significant role in your chiropractic billing practices regardless of whether you choose to accept insurance, operate a cash-based practice, or a mixture of both.

My new resource, Cash vs. Insurance for Your Chiropractic Practice: 2 Game-Changing Factors They Don’t Tell You About, walks you through Federal Medicare chiropractic billing guidelines as well as Medicaid guidelines specific to your state of practice.

This step-by-step resource will give you clarity in knowing the guidelines around these two programs so you can feel confident in your chiropractic billing practices.

Chiropractic Billing Resources

Your best course of defense to ensure you are following best chiropractic billing practices is to stay informed and up to date. How?

I’m giving you a peek into the five chiropractic billing resources I use and love.

1. CHUSA

ChiroHealthUSA (CHUSA) is completely free to chiropractors and creates a step-by-step approach for you to offer legal and compliant network-based discounts to cash, under-insured, and out-of-network patients who become members.

CHUSA provides you the security in knowing your cash discounts are compliant with federal healthcare laws.

One of my favorite things about CHUSA is their wealth of free resources that offer so much value at no cost. 

2. KMC University

KMC University is a team of certified reimbursement and compliance experts who focus on all things related to chiropractic billing practices such as Medicare, reimbursement, compliance, and documentation and coding.

While KMC University does come at cost, it helps you avoid violations and gives you the peace of mind knowing your chiropractic billing practices are sustainable and compliant.

If you’re not quite ready to make the investment, KMC University offers some reasonably priced courses and webinars and some valuable free resources to help you get started.

3. Insurance Network Newsletter

Stay updated on policy changes by subscribing to the newsletters of the health insurance networks you contract with.

Insurance companies frequently update their policies, reimbursement rates, and eligibility criteria.

By subscribing to their newsletters, you can stay informed about these changes at no cost and ensure that your chiropractic billing practices remain compliant.

4. State Chiropractic Associations

Your state chiropractic association will keep you informed about any changes to state-specific billing regulations, ensuring that your practice remains compliant.

Joining your state association will require a membership fee.

Many chiropractic associations offer educational resources, such as seminars, webinars, and conferences that can help you improve your understanding of chiropractic billing codes, claims submission, and reimbursement policies.

5. CMS Newsletter

The Centers for Medicare & Medicaid Services (CMS) offers a free newsletter to healthcare providers. Their newsletter includes Medicare and Medicaid program and policy details along with news and announcements, press releases, and upcoming educational and training events. It’s a great resource to keep you up to date at the Federal level.  

I want to leave you with a final thought: Guidelines can feel burdensome and like we’re “jumping through a lot of hoops.” I encourage you to embrace these guidelines with curiosity and a willingness to learn. After all, they’re in place as a standard of how to run your practice.

Give yourself the peace of mind in knowing what is expected of you in your chiropractic billing practices.

I’m over here jumping through hoops helping you jump through yours and cheering you on every step of the way.