Understanding Healthcare Revenue Cycle Management in Chiropractic Clinics
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Healthcare revenue cycle management (RCM) involves handling the financial process from patient registration to final payment. For chiropractors, this includes insurance checks, coding, billing, and denial handling. With rising patient volumes and complex insurance policies, chiropractic clinics face frequent payment delays and denials—making efficient RCM essential for financial stability.
Top Reasons Chiropractic Claims Get Denied
Let’s explore some specific issues that make chiropractic clinics especially prone to denials:
1. Inadequate Documentation
Chiropractic treatments often involve repetitive care plans. If providers fail to properly document medical necessity, progress notes, and treatment goals, payers may flag claims as not justified. Missing SOAP notes (Subjective, Objective, Assessment, Plan) are one of the most common culprits.
2. Incorrect Coding or Modifiers
The use of improper codes or missing modifiers can lead to instant denials. Chiropractors must use precise CPT and ICD-10 codes that reflect patient conditions and the nature of care provided. A small error in code sequencing can result in delayed payments or complete rejections.
3. Frequency Limitations
Many insurers have strict limitations on the number of chiropractic visits allowed. If a claim is submitted outside this coverage limit without the necessary medical justification, it will likely be denied.
4. Eligibility and Benefits Misunderstanding
Not verifying patient eligibility before a visit can create massive headaches. Chiropractors often treat patients under the assumption they are covered—only to later find that spinal manipulations aren’t part of the plan.
How Optimized Revenue Cycle Management Can Help
Partnering with a professional healthcare revenue cycle management provider like SharpInfo Solutions can significantly reduce these pain points. Here’s how:
✔️ Accurate Eligibility Checks
Before a patient even steps in for treatment, a solid RCM system verifies insurance coverage, co-payments, visit limits, and specific chiropractic benefits. This prevents surprises and sets expectations upfront.
✔️ Improved Coding Practices
Our trained coding specialists at SharpInfo Solutions understand the nuances of chiropractic services. With correct CPT codes and proper documentation, we minimize the chances of errors and maximize claim acceptance.
✔️ Faster Claim Submission and Follow-Up
Manual billing is time-consuming. With automated claim processing and proactive denial follow-up, our RCM team ensures that your reimbursements are processed swiftly.
✔️ Detailed Reporting & Analytics
Our dashboards provide transparent insights into A/R days, denial rates, and monthly cash flow. Chiropractors gain a better understanding of where revenue is leaking and how to plug the gaps.
What Chiropractic Clinics Can Gain with SharpInfo’s Revenue Cycle Management Expertise
When you invest in quality healthcare revenue cycle management, the benefits go beyond fewer denials:
- Improved cash flow: Timely reimbursements mean fewer cash crunches.
- Reduced admin load: Your front desk staff can focus on patient engagement instead of paperwork.
- Better compliance: Stay aligned with HIPAA and payer requirements.
- More time for care: Chiropractors can shift focus from finances to wellness.
Whether you operate a small clinic or a multi-location practice, SharpInfo Solutions can tailor RCM services to meet your specific chiropractic needs.
Conclusion: Take Control of Your Revenue Cycle Management
Chiropractic clinics are essential to modern wellness, but claim denials and revenue delays can hold them back. A smart, customized healthcare revenue cycle management strategy can turn things around—improving claim success, accelerating payments, and freeing your team from administrative headaches.
SharpInfo Solutions, based in Coimbatore, offers specialized RCM services for chiropractic and wellness clinics across India. With our deep domain expertise and a results-driven approach, we help you get paid faster, more accurately, and without stress.
We will be able to predict the outcome of the claim, even before it is submitted.
As a revenue cycle management company, we understand that the core job of the provider is patient care and not office administration. However, we also understand the criticality of ensuring optimal revenues to the provider.
Therefore, Sharp Info Solutions meticulously manages end-to-end revenue cycle management to maximize collections. Beginning from Insurance Verification to Payment Posting, every job is handled proficiently by highly experienced staff.
We are certain that our clients are assured and are relaxed.
Comprehensive End-to-End Revenue Cycle Management
Enrollment and Credentialing
Payor enrollment is a time-consuming process where attention to detail is critical and even the slightest mistake in an application can cause the entire process to halt which ultimately leads to delayed payments.
We complete all applications and necessary paperwork on your behalf with the chosen Payor networks and government entities. Follow all Payor contracts through to contract load date and provide a copy of fully executed contract and fee schedules to your Practice or Billing Company.
Eligibility and Benefits Verification
Eligibility / Benefits verification is a critical process in overall revenue cycle management. Eligibility verification is an efficient way to eliminate denials.
Our team runs through a standard and customized list of verification questions to confirm the patient’s eligibility and coverage for the services to be provided.
We will be able to predict the outcome of the claim, even before it is submitted.
Demographics and Charge entry
Charge entry is done electronically to shorten the revenue cycle days. Patient demographics and medical codes applied to charts are appropriately verified.
Every claim is verified to reduce the chance of claim rejection. Fee schedule of our clients is taken into consideration and bills are raised accordingly.
Claims are submitted to clearing house to ensure 100% accuracy. Our billers apply multiple layers of quality checks before submission of claims.
We ensure clean claims submission.
We complete all applications and necessary paperwork on your behalf with the chosen Payor networks and government entities. Follow all Payor contracts through to contract load date and provide a copy of fully executed contract and fee schedules to your Practice or Billing Company.
Medical Coding
Our medical coding services help our clients reduce their denials and optimize their revenues. Our professional coders are well experienced in procedural and diagnostic coding.
Our medical coding services are compliant with various guidelines and help our clients stay focused on their core activities. We clearly understand the liability issues associated with incorrect coding and we thrive on high quality delivery.
We assist our clients with their short-term and long-term coding assignments. We are well prepared to face the challenges related to transitions in coding.
Payment posting
Due to the sensitivity of payment posting process, accurate and efficient payment posting is inevitable for Physicians’ office. EOBs are not our bible.
We thoroughly crosscheck the EOB’s and we verify it by adjudicating it ourselves.
Our billers are known to be highly efficient and analytical in payment posting.
Their specialty lies in working on the most advanced electronic remittance scenarios such as:
- Denials
- Underpayments
- Overpayments
- Multiple Adjustments
- Automatic Cross-over
- Secondary Remittance
- Reversals and more…
Before our biller closes the payment posting, they match patient payments accepted in the front-office to encounters entered in the back-office.
Denial Management & Appeals
Denials are an epidemic to the financial health of most practices, and they have a need to be treated well in order to get you financial success.
Around 10% of the physician revenue is estimated to be lost due to lack of denial management
Billers in Sharp Info Solutions are experts in denial management. We believe in ensuring we have very less denials in the first place, and we deal with them efficiently when we have them…
Accounts Receivable Management
Account receivable is the vital part of any business. Our experienced callers use various follow-up methodologies to ensure prompt payments. We get to talk to the right person and get the claims resolved amicably.
Accuracy of the claim and the time spent on retrieving the payment are key points in optimized revenue collections. Reducing AR aging and maximizing cash flow is our goal.
Our billers have spent years on AR management. They have great understanding of claim status that they sometimes don’t even pick up the phone to follow up. They have the process knowledge at their fingertips!
Financial Management Reporting
We customize reports according to our clients’ requirements. We present periodic financial reports and other reports that include information on claims filed, payments received, receivables, and aging.
We can also customize our services as per the client’s requirements, if the client does not wish to outsource the complete RCM.
Our billers can take care of end-to-end Medical Billing requirements and can also support whenever the practice is overloaded.
Challenges that affect RCM and our answers
Sharp Info Solutions understands the criticality of financial management and the consequence of great work. Revenue cycle management involves various tasks, processes, and procedures, from when a patient account is created to when money is collected.
As a revenue cycle management company, we understand that the core job of the provider is patient care and not office administration. However, we also understand the criticality of ensuring optimal revenues to the provider.
Therefore, Sharp Info Solutions meticulously manages end-to-end revenue cycle management to maximize collections. from Insurance Verification to Payment Posting, every job is handled proficiently by highly experienced staff.
We are certain that our clients are assured and are relaxed.
Incorrect Categorization
For example, payers that we deal with and the information pertaining to whether the client is In-Network or Out-Of-Network would determine how a claim has to be submitted to maximize collections and avoid rejections. With experience and attention to details, incorrect categorization may be easily avoided. However, many associates do not categorize information properly before submission leading to rejections.
Entry Errors
With time, charge entry jobs could turn out to be a routine job. This routine nature most often causes associates to incorrectly enter charges. Most often than not, these are inadvertent and due to negligence. However, such errors could cost the provider time and money.
Knowledge Mismanagement
Revenue Cycle Management involves large amount of information, procedures, and updates. All of this information has to be recorded and organized so that they form the knowledge base for the organization. If this piece of valuable knowledge is not reviewed periodically and if it goes unused, it is as good as no knowledge. This kind of omission could lead to errors and affect collections.
RCM Associates simply don’t seem to understand
This is one major issue most providers face regardless of whether they have their billing offices in-house or outsourced. While errors cannot be completely prevented, it is always possible to pay attention to and comply with client requirements. Failure to do so will eventually affect efficiency and lead to client frustration.
Aging Claims
The primary reason for aged claims is incorrect submission of claims or lack of negotiating skills. This leads to rejections. If appeals are not made on time it further increases the operational costs and bleeds the finances of the providers.
Audits
Understanding and following legal guidelines is very important in Revenue Cycle Management. If systems are switched without proper thought, guidelines changed, or if administration standards are compromised, one may end up attracting audits. It is always better to comply than to end up facing undesired consequences.
Effects on Providers
Most Issues with Revenue Cycle management affect the providers in three significant ways
- Loss of Revenue
- Loss of time
- Additional stress
Our primary objective is to eliminate all of these issues for the providers. We will do any kind of negotiation with the payer. We will function as the billing consultants allowing the providers to focus on medical care without worrying about the hassles of collections.
Choices available for the providers
Providers have a choice of either doing their Revenue Cycle Management in-house or outsourcing it to professional companies. While errors cannot be eliminated the question really is how much is acceptable?
When RCM is done in-house, it involves managing an efficient team. Office administration and operations management will consume too much of doctors’ time. The real question is, “Is it worth the time and effort when there are professional companies who will carry out Revenue Cycle Management for you?”
If the challenges of in-house revenue management are hitting you hard and if you are considering outsourcing your Revenue Cycle Management Services, there are plenty of professional billing companies that you can choose from.
What makes us different is that we do RCM differently and so are our offerings. We pledge to the saying “It’s not the years, honey; it’s the mileage.” – Indiana Jones, Raiders of the Lost Ark
Over the years, we have learnt so much that we precisely know what works and what does not. We continue to learn each day and our understanding of various functions within RCM is very clear. Our principled workforce gives utmost importance to work ethics and the derivative is customer delight.