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How to understand the rules of running your chiropractic business

During the first year on their own, most new grads concentrate on building a practice and helping patients. But all too soon, the paperwork, the rules and other business details appear, and the worries start to set in about running your chiropractic business

The average student is in chiropractic school for about 1,350 days and, afterward, most graduating students immediately go into practice by themselves or working as an associate doctor.

During the first year on their own, most new grads concentrate on building a practice and helping patients. But all too soon, the paperwork, the rules and other business details appear, and the worries start to set in. How should the new DC manage these business matters in their new career?

Everything you need to know about the business of compliance can’t be covered in a quick read. However, there are four things every new graduate, new doctor and new businessperson needs to focus on to stay on the right side of the rules.

The Medical Review Policy (MRP)

Too often, new grads make a beeline for the top insurance carriers in their area, and they can’t wait to sign up as a preferred provider. But some do so without reviewing or understanding the insurer’s MRP, which is the proposed fee schedule or the rules for medical review.

It provides all the details that reviewers will use to adjudicate chiropractic claims in the carriers’ MRP. When providers are not familiar with these important details prior to providing and billing for services, chaos can result that could be easily avoided by following these simple steps:

Before billing any insurance carrier, and certainly before agreeing to preferred provider status, visit the carrier’s website and locate “medical policy” or “medical review policy.”

Then, search “chiropractic” and “physical therapy” to find the details applicable to the intended services.

Take special note of services or techniques that are deemed “experimental” or “not covered.”

Find out whether it’s OK to charge patients directly for these services with properly signed advance notice, and never charge them without it.


The Health Insurance Portability and Accountability Act (HIPAA) applies to everyone in health care—including chiropractors. HIPAA is the primary law that protects your patients’ protected health information (PHI) and more, including such information as phone numbers, Social Security numbers and emails. This regulation is not to be taken lightly.

With malware infections and hacking on the rise, it has never been more important to have a solid foundation of privacy and security in your practice. Don’t try to eat the elephant in one big bite, but do educate yourself about your requirements as a health care provider.

Start with these tips:

Don’t take the easy path of buying someone’s already put-together book and call it a day. There is no substitute for the personalization and the training that is required to make a compliance program your own.

Find a qualified, certified HIPAA expert to help. Most of us have already done the heavy lifting by putting together a program with training that allows you to scale and customize to your office.

Don’t skimp when setting up your office’s computers, network and security. It’s easy for someone to sit in your parking lot and jump onto your Wi-Fi network if it lacks the appropriate protection, and then it’s a hop, skip and a jump into your patient data. Wi-Fi Protected Access II (WPA2) encryption is generally sufficient.

Master the basics of coding

Coding is a language. It’s how you take the “English” description of what procedure you performed, or what diagnosis you assigned, and turn it into numbers for billing purposes. It’s easy to get befuddled when you look at the thick books full of numbers you have to wade through to find the proper descriptors for your services and diagnoses. The good news is that procedure coding (called “CPT coding”) isn’t tough to learn because there are only a few codes used in the typical chiropractic office.

Diagnosis coding in ICD-10 is also predictable. However, miscues in this department are also serious compliance issues. Slamming any coding number that seems “close enough” on a billing form is a bad idea. Remember these important details:

Study the small handful of the most common codes used in your practice. Understand what they mean when you use them. Become familiar with the prerequisites for using those codes and how employing them represents you. Compare these codes with the MRPs for carriers you use as suggested above.

When you code a service or diagnosis, you are declaring that this is what you did or saw, and your documentation backs that up. When the documentation doesn’t match, it can look like an intentional deception, even if it was just a mistake. Periodically audit your coding for accuracy.

Take the time to learn about Evaluation and Management (E/M) coding. This is the set of codes that describes the work you do when examining and evaluating patients. It tends to be the most misused and underutilized code set in chiropractic.

Learn to document for medical necessity

The process that interns go through when seeing a patient includes documenting, then going to the clinic supervisor, then documenting some more, and finally treating the patient. This type of documentation learned in school is essential for day-to-day practice life.

However, the moment you begin documenting to also support billing a third-party payer, you must raise your game. The level of documentation now must also meet the medical necessity guidelines of the payers you’re billing. Here are a few tips:

Segment your documentation into active episodes of care with a clear beginning, middle and end. Start with detailed, foundational initial visit documentation, then follow-up with the routine visit details of each visit until that episode of care ends and the patient is discharged to maintenance care.

Focus the on the progress the patient is making under your care, especially toward your stated functional goals. Think, “What has changed since the last visit?” and document it. The S (subjective) and O (objective) of your routine visit SOAP note should guide the reader to a conclusion that the patient is progressing (or not).

Detail a robust daily assessment. Take what you learned from the S and O and in the documentation say what that means to you. Does the patient require more care? And if so, why?

Starting a new business and finally getting to dive into the profession is exciting. Treasure every moment of the process. Immerse yourself in the exhilaration of using your knowledge and skills to bring about amazing change in your patients’ lives. But also take time to focus on the necessary elements of your business. Pay attention to the details, and the rest will take care of itself.

Kathy Mills Chang is a Certified Medical Compliance Specialist (MCS-P), Certified Chiropractic Professional Coder (CCPC) and Certified Clinical Chiropractic Assistant (CCCA). Since 1983, she has been providing chiropractors with billing and compliance training, advice and tools to improve the performance of their practices. She leads a team of 30 at KMC University and is an expert on Medicare, documentation and CA development. She and her team can be reached at 855-8326562 or

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