Chiropractors Must Bill Medicare
Bonnie J. Flom • April 28, 2018
Chiropractic is one of the specialties that are required to have a contract in order to treat Medicare patients. If a chiropractor does not have a Medicare contract, they are required to refer Medicare patients to another chiropractor who does have a Medicare Contract. This is true even for chiropractic services that are non-covered by Medicare, such as maintenance care.
This rule can be found in Chapter 15 of the Medicare Benefit Policy Manual in Section 40.4. It states; “the opt out law does not define “physician” to include chiropractors; therefore, they may not opt out of Medicare and provide services under private contract.”
There has been a confusing notion in the chiropractic profession that chiropractors can have the patient sign an Advance Beneficiary Notice and bill the patient without being a Medicare provider. This isn’t true.
The No Opt Out Rule for chiropractors in the Medicare program means a chiropractor can treat a Medicare patient either as a participating provider or a non-participating provider, but either way, the chiropractor has one of the two contracts with Medicare; a participating contract or a non-participating contract.
A Medicare participating contract means the chiropractor has physically signed a contract with Medicare, agrees to abide by all the rules of the program, bills Medicare and accepts assignment from Medicare. A Medicare non-participating contract means the chiropractor has physically signed a contract with Medicare, agrees to abide by all the rules of the program, but has a choice whether or not to accept assignment.
There is one more catch, a non-participating Medicare provider is still limited by how much the patient may be charged. There is a limiting fee schedule whereby the chiropractor may only bill the Medicare patient up to 115% of the allowed Medicare fee even if the chiropractor does not accept assignment and the patient receives payment directly from Medicare.
There is a good handout published by CMS called “Misinformation on Chiropractic Services” that covers this rule and many others. For a copy of this handout, search for it at http://www.cms.gov and it will be readily available. If you are unable to find it, please email bonnie@billingbuddies.com with the subject line stating; “Misinformation on Chiropractic Services” and you will receive a return copy.
Billing Buddies ® Bullet Points is brought to you by Billing Buddies. Visit us on the web at http://www.billingbuddies.com. I’m your host, Bonnie J. Flom. I have 34 years of medical billing experience and am a Certified Medical Reimbursement Specialist through the American Medical Billing Association. If you have any questions or comments, please email bonnie@billingbuddies.com or call or text 612.432.2366. Our goal at Billing Buddies is to help optimize and expedite our providers’ reimbursement so they are better able to serve their clients. If you should need medical billing or training services, please contact us. Have a great day and happy billing.
Mental health professionals across Minnesota are overwhelmed by one common issue: billing. Despite offering essential services, many therapists, counselors, and clinics find themselves buried under denied claims, confusing insurance policies, and ever-changing coding rules. According to the National Council for Mental Wellbeing, administrative hurdles are one of the top barriers preventing behavioral health providers from growing their practice. This blog highlights why mental health billing in Minnesota is so challenging and how partnering with a specialized team like Billing Buddies can transform your practice operations and revenue cycle. Table of Contents The Core Challenges of Mental Health Billing in Minnesota Top Mistakes That Lead to Claim Denials How Billing Buddies Streamlines the Process Long-Term Impact of Billing Errors on Practices Why Billing Buddies Is the Right Partner Final Thoughts + CTA The Core Challenges of Mental Health Billing in Minnesota Mental health billing isn’t just about submitting a claim. It’s about understanding Minnesota’s specific payer rules, service codes, and documentation protocols. Mental health services such as individual therapy, group sessions, psychological testing, and telehealth require precise coding, modifier use, and session tracking. The problem? These details vary widely between insurance companies—and they frequently change. Moreover, Medicaid, Medicare, and private payers all have different coverage criteria, leaving many providers frustrated and financially strained. Top Mistakes That Lead to Claim Denials Many clinics unknowingly make avoidable errors that delay payments or trigger rejections. The most common issues include: Incorrect or outdated CPT/DSM codes Missing modifiers or session limits exceeded Lack of authorization or referral documentation Inaccurate provider credentialing status Errors in patient demographics or insurance details These mistakes don’t just affect reimbursement—they waste valuable time, stress out administrative staff, and create cash flow bottlenecks. How Billing Buddies Streamlines the Process? Billing Buddies has extensive experience working with mental health providers across Minnesota. Our systems are designed specifically to address the nuances of behavioral health billing. Here’s how we simplify it for you: Custom Claim Submission : We ensure each claim is payer-compliant with accurate codes, modifiers, and documentation. Authorization and Verification : We confirm insurance eligibility and obtain pre-approvals before services begin. Automated Follow-ups : Our system tracks every claim until it is paid, with automated alerts and denial resolution steps. Credentialing Support : We assist in onboarding new providers and maintaining up-to-date records with insurers Detailed Reporting : Regular financial reports help practices understand claim patterns and optimize billing. By managing all these tasks under one roof, Billing Buddies gives providers the freedom to focus on patient care without losing money to preventable billing errors. Long-Term Impact of Billing Errors on Practices Billing mistakes don’t just hurt revenue—they hurt relationships. When claims are denied, clients may face unexpected charges, leading to dissatisfaction or even discontinuation of care. Worse, providers may begin limiting the types of insurance they accept, which reduces accessibility to mental health services. Long-term effects include: Burnout among therapists handling admin duties Delayed cash flow, affecting payroll and rent Difficulty scaling or hiring additional staff Negative client experiences and reduced referrals All of this contributes to a cycle of underperformance that is hard to break without expert help. Why is Billing Buddies the Right Partner? Billing Buddies isn’t just another billing company. We are a Minnesota-based team that understands local payer requirements, including: Blue Cross Blue Shield of Minnesota HealthPartners Medica UCare MinnesotaCare & Medicaid programs Our approach ensures your practice remains compliant, reimbursed, and stress-free. You’ll have a dedicated account manager, access to real-time claim tracking, and full transparency. Plus, we also provide credentialing services, which is critical for onboarding new therapists or expanding your practice network. Choose Billing Buddies and Focus on Healing, Not Billing Mental health billing in Minnesota doesn’t have to be a constant battle. With Billing Buddies, you get more than billing services—you gain a committed partner who understands the ins and outs of behavioral health revenue cycles. Let your focus return to your clients while we handle coding, claims, compliance, and credentialing. Explore our complete medical billing credentialing services Minnesota to start improving your revenue and peace of mind today.
Here’s a hard truth—many home health agencies are bleeding money, and they don’t even realize it. Billing errors, coding mismatches, claim denials, and outdated compliance practices cost providers thousands (sometimes millions) annually. With Medicare and Medicaid regulations constantly changing, navigating the billing landscape is not just complicated—it’s a full-time job. That’s exactly where home health billing companies come in. Specialized billing partners like Billing Buddies not only ensure accurate claims submission but also help agencies stay compliant, reduce denials, and boost revenue recovery. In this blog, we will explore the critical role of home health billing companies , why they’re essential to your agency’s success, and how to choose the right partner for long-term growth. Table of Contents: The Challenges of Home Health Billing How Home Health Billing Companies Work Key Benefits of Partnering with a Billing Service Features to Look for in a Reliable Billing Company Why Billing Buddies is a Trusted Name in the Industry Conclusion + Next Steps The Challenges of Home Health Billing Billing in the home health industry is anything but straightforward. From frequent regulatory updates to complex documentation requirements, agencies are constantly fighting fires to get claims approved. Common issues include: Missed deadlines for claims submission Incomplete or inaccurate documentation Incorrect use of OASIS data Lack of understanding of PDGM (Patient-Driven Groupings Model) High claim denial and rejection rates In-house billing teams often struggle to keep up, especially when stretched thin with administrative duties. How Home Health Billing Companies Work? Home health billing companies are third-party specialists who take the burden of billing off your team’s shoulders. These companies work remotely and collaborate with your clinicians and administrative staff to ensure every claim is clean, compliant, and submitted on time. They handle tasks like: Electronic claim submission ICD-10 and HCPCS coding Claim tracking and denial management AR (Accounts Receivable) follow-up Monthly financial reporting By outsourcing to a billing company, agencies get access to a dedicated team that’s laser-focused on maximizing reimbursements. Key Benefits of Partnering with a Billing Service A good home health billing company doesn’t just file your claims—it becomes an extension of your team. Here’s what you gain: Fewer claim denials : Experts know the right codes, documentation, and payer-specific requirements. Faster reimbursements : Timely submissions and aggressive AR follow-ups ensure quicker payments. Improved compliance : Stay aligned with ever-changing CMS guidelines. Increased revenue : Less money left on the table. Lower operational costs : Reduce the need for a large in-house billing department. It’s not just about saving time—it’s about scaling your business smarter. Features to Look for in a Reliable Billing Company Not all billing services are created equal. If you're considering outsourcing, here are the must-haves:
Chiropractors in Minnesota are working harder than ever. With growing patient loads and an increasing focus on holistic, hands-on care, many clinics expect their financial health to thrive alongside their clinical outcomes. But reality paints a different picture—thousands of dollars are lost every year due to billing inefficiencies, coding errors, and denied claims. Chiropractic billing in Minnesota isn’t just paperwork. It’s a complex system governed by changing payer policies, specific documentation requirements, and tightly monitored coding rules. Whether it’s Medicare, Medicaid, or private insurance, getting paid for chiropractic care requires far more than submitting a few codes. Without specialized knowledge or a strong billing partner, many providers are losing out on money they’ve already earned. Table of Contents Why Chiropractic Billing Is Uniquely Challenging Most Common Errors in Minnesota Clinics The Shortfalls of In-House Billing Teams How Billing Buddies Enhances Chiropractic Revenue Cycles Additional Benefits for Multi-Specialty Clinics Conclusion & Call to Action Why Chiropractic Billing Is Uniquely Challenging? Unlike general medical billing, chiropractic services are often restricted by insurance companies. Coverage depends heavily on proving medical necessity, correctly documenting every adjustment, and differentiating between active care and maintenance therapy. In Minnesota, chiropractors face added layers of complexity from regional payer preferences and Medicare strictness. Without meeting their specific conditions, claims are frequently underpaid, delayed, or outright denied. Moreover, services like therapeutic exercises or neuromuscular re-education—commonly offered alongside adjustments—must be billed in very particular ways. If documentation doesn’t fully support the procedure code, reimbursement is compromised. Most Common Errors in Minnesota Clinics Even well-run practices often fall victim to these frequent billing issues: Incorrect Modifier Usage Modifiers like AT, GP, and 59 must be applied precisely. Misuse can flag your practice for audits or denials. Incomplete Documentation Claims must clearly outline the diagnosis, treatment area, and patient progress. Vague notes are often rejected. Neglected Denial Management Many clinics fail to follow up on denied or underpaid claims, leading to thousands of unrecovered dollars. Inadequate Eligibility Verification Not checking insurance details before appointments results in unpaid services and frustrated patients. These issues, while avoidable, are common in fast-paced environments where staff are stretched thin and billing knowledge is limited. The Shortfalls of In-House Billing Teams Having a billing team on-site may seem practical, but the reality often proves otherwise. Most in-house setups face significant limitations: Lack of Continuing Education Payers frequently update policies and code requirements. Without regular training, your billing may be outdated. Inconsistent Follow-Through If someone is out sick or leaves the team, unpaid claims can sit unaddressed for weeks. No Strategic Oversight In-house teams rarely offer financial analysis or reimbursement trend tracking, which are vital for clinic growth. Limited Capacity With front desk and scheduling duties piled on top, billing gets rushed—or worse, deprioritized entirely. Ultimately, billing becomes a reactive task, rather than a proactive system for maintaining and growing your revenue. How Billing Buddies Enhances Chiropractic Revenue Cycles? Billing Buddies brings expert-level precision to chiropractic billing in Minnesota. With a deep understanding of payer requirements and chiropractic documentation protocols, they ensure your claims are compliant, complete, and submitted correctly the first time. Here’s how they transform your billing process: Claim Accuracy : Clean submissions reduce rejections and speed up reimbursements. Denial Resolution : Rejected claims are followed up with appeals and corrections—no revenue left behind. Documentation Coaching : Providers receive feedback to help align notes with payer standards. Custom Reporting : Get monthly insights into reimbursement patterns, errors, and growth areas. Credentialing Support : Stay up-to-date with insurance panels and avoid lapses that halt payment. By working as an extension of your clinic, Billing Buddies handles the back-end stress while you focus on patient care. Additional Benefits for Multi-Specialty Clinics If your chiropractic clinic also provides counseling or integrative health services, Billing Buddies offers even more value. Their team is equally skilled in handling mental health billing and credentialing services , allowing multi-specialty clinics to consolidate billing with one reliable partner. This reduces overhead, improves billing consistency across departments, and keeps your operations running smoothly without the chaos of coordinating multiple vendors. Strengthen Your Billing, Strengthen Your Practice For Minnesota chiropractors, delivering exceptional care is only half the job. The other half lies in managing the business side effectively—especially billing. If your clinic is tired of underpayments, inconsistent cash flow, and billing guesswork, it’s time for a better solution. Billing Buddies provides the specialized knowledge, accountability, and strategy your clinic needs to thrive financially. From coding to collections, they ensure that every adjustment you make results in a proper reimbursement. Partner with Billing Buddies today.