How Do I Choose the Right Medical Billing Company for My Chiropractic Practice in 2026?
It comes down to three things: specialty expertise, transparent communication, and a track record of actually recovering revenue.
If you're reading this, you've probably been here before.
Maybe you're "trying to bounce back from another billing company" that didn't deliver. Maybe you've been handling billing in-house and you're tired of "hoping for the best" with every claim. Or maybe you're scaling and your current setup can't keep up.
Whatever brought you here, the goal is simple: find a partner who makes billing feel like a weight lifted.
The 2026 regulatory environment makes this decision more important than it's been in years. The CMS 2026 Medicare Physician Fee Schedule introduced new efficiency adjustments. Private payers keep tightening documentation requirements.
A billing partner who understood the landscape two years ago may not be equipped for what's happening now.
This guide walks through what to look for, what questions to ask, and how to tell whether a billing company can actually protect your revenue. Whether you're changing medical billing partners or outsourcing for the first time, you'll have a clear framework.
What's Changed About Billing in 2026
Understanding the current regulatory landscape helps you ask better questions when evaluating billing partners.
The 2026 Medicare Picture
The CMS 2026 Physician Fee Schedule final rule brought a 3.26% conversion factor increase for most physicians.
That sounds like good news. And it is.
But the details matter for chiropractic practices.
Medicare continues to narrow what qualifies as reimbursable active treatment versus maintenance care. Their "Documentation Compliance Audit Initiative" means more random post-payment reviews.
Claims that would have slipped through a few years ago are now getting flagged.
The AT modifier requirement hasn't changed, but enforcement has. Every Medicare spinal manipulation claim (98940, 98941, 98942) needs the AT modifier to indicate active treatment.
Skip it, and the claim gets denied automatically.
This single requirement is one of the most common reasons for chiropractic claim denials.
A billing company that truly understands chiropractic billing should discuss these requirements without prompting. If they can't explain the AT modifier or the active-versus-maintenance distinction, they're not ready to handle your Medicare claims.
Private Payers Are Paying Attention Too
Private insurance companies tend to follow Medicare's lead. 2025-2026 has been no exception.
Major payers like UnitedHealthcare and Cigna now require minimum outcome assessment scores every 30 days for ongoing treatment. Some Blue Cross Blue Shield plans have started pre-payment reviews for high-volume providers.
The American Chiropractic Association has noted increasing documentation requirements and rising denial rates for chiropractic services in recent years.
The pattern is clear: payers want more documentation, more justification, and more proof that treatment is working.
A billing partner who isn't staying current with these changes will struggle to get your claims paid.
What This Means for Your Search
When you're evaluating billing companies, you're really asking one question: "Can this team navigate the 2026 landscape and get my claims paid?"
Look for partners who can speak specifically about recent regulatory changes.
Ask them what's different about billing chiropractic in 2026 compared to 2024. Their answer tells you whether they're actively engaged with the industry or operating on autopilot.
Specialist vs. Generalist: Why It Matters
Not every billing company can handle chiropractic claims well. The specialty has unique requirements that generalist billers often miss.
What Makes Chiropractic Billing Different
Chiropractic billing isn't just medical billing with different codes.
The recurring treatment model, the constant need to prove medical necessity, and specialty-specific modifiers create a distinct set of challenges.
Here's what makes chiropractic billing unique:
- The AT modifier - Required on every Medicare spinal manipulation claim to indicate active (not maintenance) treatment. Without it, claims are denied automatically.
- Medical necessity documentation - Each visit needs to demonstrate functional improvement or continued treatment need. Vague notes lead to denials.
- Visit limits - Many insurance plans cap covered visits annually. Missing this leads to surprise non-payment.
- Maintenance vs. active care - Medicare doesn't pay for maintenance care. The distinction requires clinical judgment that automation can't provide.
- Personal injury complexity - PI claims involve liens, attorney communication, and settlement tracking. General billing software doesn't handle these workflows.
A billing company might be excellent at orthopedic or family practice billing and still struggle with these chiropractic-specific requirements.
When evaluating partners, ask directly about their experience with spinal manipulation codes, the AT modifier, and understanding ICD-10 Excludes notes in chiropractic contexts.
Platform-Agnostic vs. Platform-Locked
Some billing companies are tied to specific EHR platforms. If you want their billing services, you need to use their software.
This creates problems when you're already invested in an EHR you like.
Whether you use Jane App or ChiroTouch, switching software to accommodate a billing company means retraining staff, migrating data, and potentially losing workflows you've built over years.
Platform-agnostic billing partners work with your existing systems instead.
They become proficient in multiple EHR platforms and can often spot optimization opportunities within your current software.
When clinics describe working with the right billing partner, they talk about "retained control" and "everything documented clearly."
That sense of control comes from keeping your preferred systems while adding billing expertise on top.
Human Intelligence vs. Automation-Only
AI-powered billing platforms have become more common. They promise automation, speed, and lower costs.
And AI does excel at certain tasks.
Catching obvious coding errors. Automating eligibility checks. Flagging claims that need attention.
But chiropractic billing often requires something AI can't provide: nuanced judgment about medical necessity and the ability to argue a complex appeal with a payer representative.
When an insurance company denies a claim for "lack of medical necessity," the appeal requires a human who can:
- Review the clinical documentation in context
- Understand why treatment was appropriate for this specific patient
- Communicate effectively with the payer
That's not something an algorithm handles well—at least not yet.
The most effective billing partners combine automation for efficiency with human expertise for complex situations. They use technology to handle routine tasks while reserving attention for cases that require judgment and advocacy.
Understanding the Numbers That Matter
Every billing company claims good results.
The difference is whether they can show you the data.
First-Pass Claim Acceptance Rate
The first-pass acceptance rate measures how many claims payers accept on initial submission, without needing correction.
Industry leaders achieve rates above 95%.
Practices without professional billing management typically see 80-85%.
This metric matters because rejected claims require rework. Each rejection adds time before you get paid and increases the risk that the claim never gets collected.
When a billing company mentions their acceptance rate, ask follow-up questions:
- How is this calculated? (Some companies exclude certain claim types to inflate the number)
- What's the rate specifically for chiropractic claims?
- What happens to claims that aren't accepted on first pass?
A verifiable first-pass rate above 95% suggests solid claim scrubbing processes and deep understanding of payer requirements.
Denial Rate and Recovery Rate
Beyond initial acceptance, you need to understand what happens when claims get denied.
Two practices can have identical denial rates but very different outcomes depending on how well those denials get worked.
According to the Healthcare Financial Management Association, 15-20% of healthcare claims face initial denials. For chiropractic, that number can climb higher when billers don't understand medical necessity documentation requirements.
The good news: professional billing management can reduce denial rates to 3-5% and recover 70-80% of initially denied claims.
A systematic approach to denied claims includes root cause analysis to prevent the same errors from recurring.
Ask potential partners about their denial management process. You want specifics: how they track denials, how quickly they respond, what their recovery rate looks like, and whether they charge extra for appeals.
AR Aging: Where Your Money Actually Sits
Accounts receivable aging shows how long it takes to collect on submitted claims.
Healthy AR means most revenue comes in within 30-60 days. Minimal amounts should sit in the 90+ day bucket.
Here's what healthy versus struggling AR distribution looks like:
| Current (0-30 days) | 50-60% | 30-40% |
| 31-60 days | 20-25% | 20-25% |
| 61-90 days | 10-15% | 15-20% |
| 91-120 days | 5-10% | 10-15% |
| 120+ days | Less than 5% | 15-25% |
If a potential billing partner can't provide clear AR aging reports or seems reluctant to discuss these metrics, that tells you something.
Transparency about performance should be a baseline expectation.
Pricing Models: What You're Actually Paying For
Billing company pricing can be structured several ways. Each has advantages and potential hidden costs.
Here's how the two main pricing models compare:
| Best For | Growing practices, variable volume | Established practices, high volume |
| Risk Alignment | High - biller shares your incentive | Low - biller paid regardless |
| Cost Predictability | Variable month-to-month | Fixed, easy to budget |
| Scaling | Costs rise with revenue | Costs stay fixed |
| Typical Use | Most common model | Less common |
Percentage of Collections
Most chiropractic billing companies charge between 5% and 10% of collected revenue.
This model aligns incentives. The billing company earns more when you collect more.
Advantages of percentage-based pricing:
- You only pay when you get paid
- The billing company is motivated to maximize collections
- Costs scale naturally with practice volume
- Lower upfront risk for newer practices
When evaluating percentage-based pricing, confirm exactly what the percentage applies to.
Some companies calculate based on gross charges rather than net collections. Others apply the percentage to patient payments in addition to insurance. Ask specifically.
A practice collecting $50,000 monthly at 5% pays $2,500 in billing fees. That same practice collecting $100,000 monthly would pay $5,000.
The math works when collections improve enough to offset the cost.
Flat Fee Models
Some billing companies charge a fixed monthly rate regardless of collections.
Fees typically range from $1,000 for solo practitioners up to $3,000+ for multi-provider practices.
Flat fees provide predictable monthly expenses. That makes budgeting simpler. They work well for established practices with consistent volumes.
The tradeoff: the billing company doesn't directly benefit from maximizing your collections.
Their incentive is to keep you as a client, not necessarily to recover every possible dollar. That's not automatically a problem, but it's worth understanding.
Hidden Fees to Watch For
Beyond base pricing, billing companies may charge for services you might assume are included:
- Per-claim fees - Some charge $1-5 per claim on top of other fees
- Denial appeal fees - Reworking denied claims may cost extra
- Setup or onboarding fees - Initial account setup can range from nothing to several hundred dollars
- Reporting fees - Access to detailed reports may require premium tiers
- Credentialing fees - Provider enrollment with payers may be separate
A billing company quoting 4% might actually cost 6-7% once all fees are factored in.
Request a complete fee schedule in writing before signing anything.
Questions to Ask During Discovery
The discovery call is your chance to evaluate whether a billing company can actually deliver.
Come prepared with specific questions.
Chiropractic Expertise Questions
Start by probing their specific experience with chiropractic billing:
- "How many chiropractic practices do you currently serve?" - Look for meaningful chiropractic experience, not general medical billing with a few chiro clients.
- "Walk me through how you handle a Medicare spinal manipulation claim." - They should mention the AT modifier, medical necessity documentation, and the active-versus-maintenance distinction without you bringing it up.
- "What's your experience with [your EHR platform]?" - If you use Jane App or ChiroTouch, they should describe specific workflows and integration points.
- "How do you stay current with Medicare and payer policy changes?" - Quality partners have systematic processes for monitoring and adapting.
"Can you explain when to use different billing codes and why it matters?" - This tests practical coding knowledge.
Communication and Transparency Questions
Communication breakdowns are among the most common complaints about billing companies. Establish expectations upfront:
- "What reports will I receive and how often?" - Expect monthly AR aging reports, claim status summaries, and denial trend analysis at minimum.
- "Who is my primary point of contact?" - You should have a dedicated contact rather than a generic support queue.
- "What's your typical response time?" - Same-day acknowledgment and 24-48 hour resolution for routine issues is reasonable.
"How will you communicate about claims that need clinical input?" - There should be a clear workflow for questions about documentation or coding decisions.
Technology and Integration Questions
Your billing partner needs to work within your existing technology ecosystem:
- "What clearinghouse do you use?" - Common clearinghouses include Claim.MD, TriZetto, and Change Healthcare. Understanding the benefits of Claim MD clearinghouse and similar platforms helps you evaluate their technology choices.
- "How do you handle eligibility verification?" - Real-time eligibility checks should be standard, not an add-on.
"What security measures protect patient data?" - HIPAA compliance is mandatory. Ask about encryption, access controls, and security audits.
Transition Questions
The transition period is when billing partnerships succeed or struggle:
- "What does your onboarding process look like?" - A structured 30-day implementation timeline with clear milestones is reasonable.
- "How do you handle AR cleanup from previous billing?" - Outstanding claims need attention during transition.
"Will there be a gap in claim submissions?" - There shouldn't be. A solid billing partner can submit new claims immediately while cleaning up historical AR.
Red Flags to Watch For
Not every billing company is a good fit. Some warning signs should prompt you to keep looking.
Vague Performance Metrics
If a billing company can't or won't provide specific performance data, that's a concern.
Claims like "we help practices collect more" without numbers to back it up suggest either poor performance or lack of systematic tracking.
A company confident in their results welcomes scrutiny.
Specific concerns:
- Unable to quote their first-pass acceptance rate
- No data on denial rates or recovery percentages
- Reluctance to provide references from current chiropractic clients
- Testimonials only from practices in other specialties
One-Size-Fits-All Approach
Chiropractic practices vary in their billing needs. A solo practitioner has different requirements than a multi-location practice with PI and workers' comp cases.
Watch for billing companies that:
- Quote pricing without understanding your practice volume and complexity
- Can't explain how they'll adapt to your specific workflow
- Insist on specific EHR platforms without understanding your current setup
- Dismiss questions about your unique billing challenges
The discovery process should involve them asking as many questions as you do.
If they're ready to sign you up without understanding your practice, they're selling a commodity service rather than building a partnership.
Aggressive Sales Tactics
Billing companies that use high-pressure tactics deserve skepticism:
- Promises to "double your collections" or similar guaranteed improvements
- Pressure to sign immediately without time to evaluate
- Claims about proprietary technology that competitors can't match
- Creating urgency around your current billing situation
The best billing partners are confident enough in their value that they don't need manipulation.
They welcome you taking time to make an informed decision.
Poor Transition Support
How a company handles onboarding tells you how they'll handle your ongoing needs:
- No dedicated onboarding manager or process
- Vague timelines with no specific milestones
- Unwillingness to address historical AR cleanup
- Minimal training or documentation
Ask to speak with a client who recently completed the transition. Their experience reveals what you can expect.
Working With Your EHR: Jane, ChiroTouch, and Others
Your EHR platform affects your billing workflow. Understanding platform-specific considerations helps you ask better questions.
Jane App Considerations
Jane App has become popular among chiropractic practices for its intuitive interface and integrated scheduling.
The platform supports insurance billing through integration with Claim.MD, enabling eligibility checks, claim submission, and ERA posting.
Some users find that while Jane is excellent for scheduling and charting, the insurance billing workflow can be complex for practices with diverse payer mixes.
The platform works well when paired with a billing partner who understands both its capabilities and its limitations.
A billing partner experienced with Jane should navigate the insurance workflow efficiently, set up proper clearinghouse integration, and train your team on billing-specific features.
ChiroTouch Considerations
ChiroTouch remains the dominant EHR in chiropractic, serving over 12,500 practices.
The platform offers integrated billing through its CT ProClear and CT MaxClear products.
Recent transitions from server-based ChiroTouch to the cloud version have created challenges for some practices. Reviews mention migration difficulties and learning curve frustrations, particularly around billing modules.
A billing partner familiar with ChiroTouch should understand both the legacy server-based system and the cloud version.
If you're in the middle of a ChiroTouch migration, your billing partner can help ensure claims don't get lost during the transition.
Platform-Agnostic Advantages
The ideal billing partner works with multiple platforms rather than being tied to one:
- No forced software changes - You keep systems your team already knows
- Broader expertise - They've seen what works across different platforms
- Future flexibility - If you switch EHRs, your billing relationship continues unchanged
- Optimization opportunities - They can identify best practices from other platforms
Ask potential billing partners which EHR platforms they actively support.
If they only work with one or two systems, consider whether that limitation affects your options.
Building a Lasting Partnership
Selecting the right billing company is just the beginning.
How you structure and maintain the relationship determines long-term success.
Setting Expectations Early
Before signing any agreement, make sure both parties understand:
- Performance benchmarks - What specific metrics will you track? What targets represent success?
- Communication cadence - How often will you connect and through what channels?
- Escalation procedures - When issues arise, who do you contact and what's the expected resolution timeline?
- Review schedule - How often will you formally evaluate the relationship?
Document these expectations in writing.
Verbal agreements about service levels often lead to misunderstandings.
Your Part in the Partnership
Even with the best billing partner, your practice has responsibilities that affect billing success:
- Complete documentation - Clinical notes must support the codes billed
- Timely charge entry - Delays in entering charges delay claim submission
- Responding to questions - When the billing team needs clarification, quick responses keep claims moving
- Providing feedback - If something isn't working, communicate early
The most successful billing relationships involve regular communication from both sides.
Your billing partner should feel like an extension of your team.
Monitoring Performance
Don't assume the relationship is working just because money is coming in.
Regular monitoring reveals trends before they become problems:
- Monthly review of key metrics - Track first-pass rate, denial rate, days in AR, and collection percentage over time
- Quarterly business reviews - Schedule time to discuss trends, challenges, and improvement opportunities
- Annual contract evaluation - Before renewal, assess whether the partnership is delivering expected value
If metrics are trending in the wrong direction, address it immediately.
A quality billing partner welcomes feedback and commits to improvement.
Frequently Asked Questions
How much do most chiropractic billing companies charge?
Chiropractic billing companies typically charge between 5% and 10% of collections or a flat monthly fee ranging from $1,000 to $3,000 depending on practice size.
Percentage-based pricing aligns the billing company's success with yours. They earn more when you collect more.
Flat-fee arrangements work better for high-volume practices where percentage-based pricing would become expensive.
Beyond the base fee, watch for additional charges: per-claim fees, appeal charges, credentialing fees, setup costs. Request a complete fee schedule to understand the total cost.
What is the average clean claim rate for a chiropractic practice?
Top-performing chiropractic practices achieve clean claim rates above 95%.
The industry average without professional billing management hovers around 80-85%.
Professional billing management can reduce denial rates to 3-5% through proper documentation support, accurate coding, and thorough claim scrubbing. When reading insurance EOBs and interpreting insurance denial codes, experienced billers catch issues faster than staff juggling multiple responsibilities.
Should I hire a local billing person or a remote billing company?
Remote billing companies often provide better value than in-house staff.
They offer redundancy, specialized expertise, and no training or turnover costs.
When an in-house biller takes vacation or leaves for another job, your billing stops. A remote team doesn't have that single point of failure.
In-house billing typically costs $3,000-$5,000 per provider monthly when factoring in salary, benefits, training, software, and overhead. Remote billing services at 5-7% of collections often cost less while providing deeper expertise.
How long does it take to switch chiropractic billing partners?
A typical transition takes 2-4 weeks for full implementation.
This includes verifying credentialing, establishing EHR access, documenting current workflows, and assessing any AR cleanup needs.
Quality billing partners provide a structured onboarding process with clear milestones.
There should be no gap in claim submissions. New claims should go out immediately while historical AR is addressed in parallel.
What questions should I ask during a billing discovery session?
Essential questions reveal a billing company's true capabilities:
- What is your first-pass claim acceptance rate specifically for chiropractic claims?
- How do you handle denied claims and what's your recovery rate?
- Do you have direct experience with my EHR platform?
- What reporting will I receive and how often?
- Who will be my primary contact?
- How do you stay current with Medicare and payer policy changes?
- Can you provide references from current chiropractic clients?
The discovery session should feel like a two-way conversation.
If the billing company doesn't ask detailed questions about your practice, they're not preparing to serve you well.
Can a general medical billing company handle the AT modifier?
General medical billing companies often struggle with chiropractic-specific requirements like the AT modifier for Medicare claims.
The AT modifier indicates active treatment versus maintenance care. Without it, Medicare automatically denies spinal manipulation claims.
Beyond the AT modifier, chiropractic billing requires understanding medical necessity documentation, visit limits, and personal injury workflows.
This specialized knowledge explains why chiropractic-focused billing partners tend to outperform generalist companies.
How do I know if my billing company is actually working my AR?
Request detailed aging reports showing claims status by age bucket (30, 60, 90, 120+ days).
A quality billing partner provides transparent reporting on follow-up activities, appeal submissions, and recovery rates.
Warning signs that AR isn't being worked:
- Growing AR over 90 days without explanation
- No documentation of follow-up activities on aging claims
- Generic responses without specifics when you ask about particular claims
Your billing partner should communicate proactively about aging AR and have systematic processes for following up before claims become uncollectible.
What is the difference between percentage-based and flat-fee billing?
Percentage-based billing (typically 4-9% of collections) aligns incentives. The billing company earns more when you collect more.
Flat-fee models ($1,000-$3,000 monthly) provide predictable costs but don't directly incentivize maximum collections.
Many practices prefer percentage-based models because the billing company shares in both the risk and reward.
Making Your Decision
Choosing the right billing partner comes down to capability, compatibility, and communication.
The billing company you select should demonstrate deep chiropractic expertise, integrate smoothly with your existing systems, and communicate transparently about performance and challenges.
Take time to compare at least two or three serious candidates.
Speak with their references. Ask the tough questions. Trust your instincts about how the relationship will function day-to-day.
The right partner should make you feel confident that your revenue is protected. Like a "huge weight off your shoulders," as many clinic owners describe it.
That peace of mind is worth the effort of finding the right fit.
Choosing the right billing partner is a big decision—and after reading all of this, you might be wondering where to even start.
If you're thinking "this all makes sense, but I don't have time to figure it out," you're not alone. Most clinic owners we work with felt the same way before they realized how much revenue was slipping through the cracks.
That's why we offer a free discovery call. It's a chance to talk through your current billing situation and get clarity on what's working, what's not, and what your options are.
We'll help you understand:
- Where your claims might be getting stuck
- What's causing denials or delays
- Whether your AR is healthy or needs attention
- How your current process compares to best practices
- What a partnership with Bushido would actually look like
Book a Call — no pressure, no obligation, just a straightforward conversation about your billing.
Because every week you spend researching instead of deciding is another week of claims sitting in limbo and revenue waiting to be collected.
SCHEDULE YOUR FREE DISCOVERY SESSION TODAY.
Copyright 2026 | All rights reserved | Web Design by iTech Valet