How to Fix the 7 Top Chiropractic Billing Issues in 2025

Key Takeaways

• Chiropractic billing has challenges like strict documentation requirements, coding errors, and denied claims.
• Verifying coverage upfront, training staff, and following payer rules can prevent billing issues.
• Automating processes like claims tracking and ERA posting saves time and reduces errors.
• ChiroSpring chiropractic billing software simplifies billing with features like claim scrubbing and AI-driven insights.

Chiropractic billing is challenging due to changing regulations, evolving codes, and the constant need to chase reimbursements. Learn how to prevent billing errors and denied claims from affecting your bottom line in 2025.

Challenges of Chiropractic Billing

While all healthcare billing has its challenges, chiropractic billing comes with a unique set of challenges, including:

• Stricter documentation standards: Insurers and CMS often require detailed records to prove medical necessity, particularly for services like spinal manipulation. Incomplete documentation can lead to denied claims or audits.
• Narrow Medicare coverage: Medicare only reimburses spinal subluxation-related services, requiring specific diagnosis and treatment codes that align perfectly.
• Complex coding requirements: Chiropractors use codes for adjustments, exercises, and modalities that require precise documentation to avoid errors.
• High claim scrutiny: Insurers often flag chiropractic care for overutilization, leading to more audits and rejections than in other specialties.

With so many moving parts to manage, it’s easy to see how even small errors can lead to major issues.  

For example, a chiropractic clinic recently faced $170,000 in penalties for billing Medicare for unapproved treatments and devices. Medicare denied the claims for non-compliance with coverage rules, causing financial losses and reputational harm.

Mistakes like these serve as a warning. Staying compliant with payer guidelines, billing requirements, and documentation isn’t optional—it’s how you protect your practice.

Tips for Fixing Chiropractic Billing Issues

Billing challenges don’t have to feel overwhelming. With the right strategies, tools, and attention to detail, you can sidestep common pitfalls and keep your revenue flowing.

Here’s how to tackle some of the most frequent billing issues chiropractors face:

1. Coding Errors and Compliance

It’s easy to slip up with outdated codes, incorrect CPT modifiers, or undercoding/upcoding services.

Even small mistakes in coding can lead to claim denials, delays, or even audits.

How to Fix It:

• Stay updated on codes: CMS updates codes regularly. Use dependable resources or practice management software with built-in updates to keep everything current.
• Train your staff: Regular training helps your team stay sharp on diagnosis codes and payer-specific rules.
• Leverage claim scrubbers: ChiroSpring’s claim scrubbers catch errors before submission, like inactive codes and missed diagnosis pointing, reducing rejections and rework.

2. Lack of Documentation  

Insurers require clear proof of medical necessity for every service. Incomplete SOAP notes lead to denied claims and audits.

‍Documentation issues don’t just cause delays—they disrupt workflows and hurt revenue.

How to Fix It:

• Make documentation effortless: Use customizable templates and workflows to capture every detail. ChiroSpring’s SOAP templates and macros accelerate the process, helping you stay compliant without sacrificing accuracy.
• Keep billing and notes connected: Integrating documentation and billing reduces errors and saves time. ChiroSpring connects the two, automatically generating claims from signed SOAP notes to capture every detail.
• Audit proactively: Regularly check your notes and claims to catch gaps before payers do. ChiroSpring’s tools make tracking and correcting issues easy without extra stress.

3. Denied or Rejected Claims  

Denied or rejected claims can throw your entire workflow off track. They delay payments, waste staff time, and cause unnecessary frustration.

Most rejections are due to preventable issues like incorrect patient info, coding errors, or missing pre-authorizations.

How to Fix It:

• Verify upfront: Always confirm patient insurance details, eligibility, and demographics before providing treatment.
• Use smart billing tools: ChiroSpring speeds up claims processing by reducing denials with advanced claim scrubbing. It flags errors before submission and streamlines resubmissions with tracking tools and a built-in clearinghouse.
• Streamline pre-authorizations: For procedures requiring insurance approval, maintain a system to secure pre-approvals before moving forward.

4. Handling Bundled and Unbundled Codes

Mismanagement of bundled (or unbundled) services can trigger red flags with payers. Some services must use a single bundled code. Others, like same-day exams or treatments, need separate modifiers.

How to Fix It:  

• Understand payer requirements. Familiarize yourself with how payers handle specific codes. Some combine traction therapy with spinal manipulations, while others don’t.
• Use modifiers correctly: A modifier like “-25” signals that an exam and treatment were necessary during a visit. ChiroSpring’s billing platform includes built-in tutorials to guide proper code usage and reduce costly errors.

5. Insufficient Training in Billing Practices  

Billing errors often stem from gaps in training. Team transitions or outdated knowledge can cause missed deadlines, coding mistakes, or improperly submitted claims.

How to Fix It:

• Prioritize ongoing training: Schedule workshops or courses to update your team on billing rules and payer requirements.
• Opt for automation: Automated systems like ChiroSpring reduce manual workload and improve accuracy by integrating billing procedures into everyday operations.

6. Lack of Claims Tracking  

Without a clear system in place, claims can get stuck or lost in the process, leading to payment delays and gaps in cash flow. Manually keeping track of claims only increases the chance of errors.

How to Fix It:

• Use a centralized tracking system: ChiroSpring’s claim logs let you track each claim step by step and easily spot what needs attention.
• Automate ERA posting: Automation matches payments quickly and accurately, saving your team valuable time.
• Follow up regularly: Set weekly time to review claims and resolve any delays or denials.

7. Billing for Non-Covered Services  

It’s frustrating to find out too late that insurance won’t cover a service. Billing issues and unexpected costs can create stress for your team and strain trust with patients.

How to Fix It:

• Check coverage ahead of time: Confirm what insurance will cover, along with copays and deductibles, before treatment begins.
• Be upfront with patients: Inform patients early if insurance won’t cover a service and explain their payment responsibility.

Stabilize Your Chiropractic Practice’s Revenue in 2025  

Chiropractic billing shouldn’t hold your practice back. As you get ready for the new year, efficient billing is important. It keeps your cash flow steady, reduces stress, and gives you more time for your patients.

With ChiroSpring, you can simplify every part of the process. It allows you to automatically create claims from treatment notes and scrub them for errors before submission. You can also streamline payments with tokenized credit cards and instant payment links. Plus, AI predictions reduce denials and improve coding accuracy.

Take control of your billing and set your chiropractic office up for success in 2025. Schedule a demo today to see how ChiroSpring's chiropractic software can make billing one less thing to worry about.

Chiropractic Billing FAQs

What steps should I take if a claim is denied or rejected? First, review the explanation of benefits (EOB) or rejection notice to find the reason for the denial or rejection. Common issues include coding errors, incomplete patient information, or questions about medical necessity. Once you’ve identified the issue, correct it, resubmit the claim, and follow up promptly. Tools like ChiroSpring can streamline this process with built-in claim tracking and error detection features.

What should I do if a patient’s insurance doesn’t cover certain chiropractic services? Discuss uncovered services with the patient upfront. Clearly explain what their insurance won’t cover and provide an estimate for the costs. To make payments easier, offer options like credit card tokenization or flexible payment plans. Transparent communication builds trust and simplifies the billing process for everyone.

Are there specific insurance rules for chiropractic care that differ from other specialties? Yes, chiropractic billing often has stricter rules. For example, Medicare only covers active treatment for spinal subluxations and excludes maintenance care or other therapies. Payers frequently flag chiropractic services for overutilization, so it's important to follow their guidelines and document medical necessity to avoid denials.

Does ChiroSpring support billing for multiple locations or providers? Yes, ChiroSpring is a cloud-based chiropractic EHR designed to simplify billing for multiple locations or providers. It centralizes billing data, tracks claims by location or provider, and ensures accuracy across the board. This flexibility helps practices with multiple offices stay organized and efficient.

How does ChiroSpring save time on billing? ChiroSpring’s chiropractic EHR software automates time-consuming billing tasks like claim creation, ERA posting, and error detection. Its cloud-based system connects billing directly to patient records and scheduling, reducing manual work and streamlining your workflow.

Billing and Coding: Chiropractic Services. (2023). Centers for Medicare & Medicaid Services. https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleId=56273

The Ultimate Chiropractic Billing Cheat Sheet. (2024, September 27). ChiroSpring. https://www.chirospring.com/articles/ultimate-chiropractic-billing-cheat-sheet

U.S. Attorney Announces an Additional Civil Settlement with Chiropractor and His Practice as Part of National Effort to Combat Electronic Stimulation Fraudulent Billing Scheme. (2024, October 7). Justice.gov; U.S. Department of Justice. https://www.justice.gov/usao-edpa/pr/us-attorney-announces-additional-civil-settlement-chiropractor-and-his-practice-part