Chiropractic Care

Introduction

This case study highlights how a multi-provider chiropractic clinic partnered with a medical billing company to streamline its revenue cycle management (RCM). The collaboration led to faster reimbursements, reduced denials, improved documentation accuracy, and stronger financial performance — allowing providers to focus more on patient care and less on administrative tasks.

Background

The chiropractic practice provides comprehensive musculoskeletal and wellness care, including spinal adjustments, physical therapy modalities, and pain management services. Despite a loyal patient base and strong referral volume, the clinic faced challenges in maintaining efficient billing operations across multiple locations. Increasing payer scrutiny, documentation errors, and high claim rejections were significantly impacting cash flow.

Revenue Cycle Challenges

• Frequent Coding Errors: Misuse of CPT codes (e.g., 98940–98943) and modifier errors resulted in claim rejections and underpayments.
• Incomplete Documentation: Lack of detailed treatment notes and improper linking of diagnosis codes (ICD-10) led to frequent payer denials.
• Manual Verification & Authorization Delays: Insurance verifications and pre-authorizations were handled manually, delaying patient scheduling and billing.
• Compliance Issues with Payer Policies: Inconsistent adherence to payer documentation and frequency limitations triggered audits and delayed payments.
• Inefficient A/R Follow-Up: Aging claims and partial payments were not being tracked effectively, causing revenue leakage.

Objectives

• Enhance Coding Accuracy: Standardize coding practices for all providers to ensure compliance and maximum reimbursement.
• Improve Documentation Compliance: Align SOAP notes with payer requirements to reduce denials.
• Streamline Verification and Pre-Auths: Reduce administrative delays by automating eligibility and authorization workflows.
• Accelerate Cash Flow: Reduce average payment turnaround time by improving claim accuracy and follow-up processes.
• Recover Aged Revenue: Strengthen A/R management to minimize outstanding and underpaid claims.

Intervention

The medical billing company implemented a comprehensive, chiropractic-specific RCM improvement plan:

• Specialty Coding & Documentation Audit: Conducted initial audits to identify gaps in CPT, modifier, and diagnosis code usage. Provided training to all providers on documentation and coding best practices.
• Automated Eligibility & Pre-Auth Verification: Integrated real-time insurance verification tools within ChiroTouch to validate coverage before patient visits.
• SOAP Note Optimization: Customized templates for accurate documentation of medical necessity and treatment frequency to comply with payer guidelines.
• A/R Recovery Program: Deployed a dedicated A/R team to prioritize and recover aged accounts while improving payer communication and appeals management.
• Ongoing Compliance Monitoring: Set up monthly compliance reviews and feedback sessions with providers to maintain billing accuracy and prevent future denials.

Results

Conclusion

By outsourcing its revenue cycle management to a specialized medical billing partner, the chiropractic clinic achieved measurable financial and operational improvements. The partnership helped standardize coding, reduce administrative delays, and significantly enhance cash flow — ultimately allowing the providers to dedicate more time to patient outcomes and business growth.

Customer Testimonials

1. “Overall I am pleased with the support. The response time and communication is fine. Knowledge about billing and claims is excellent.”