Chiropractic Invoicing Software

Invoicing in a Chiropractic Practice

Many chiropractic charges are billed by invoice, not by claim. A family on a wellness plan pays a monthly fee or buys a block of visits. A self-pay patient pays per visit, at a price that should match the estimate they were given. A Medicare patient owes for the exam and x-rays, which Medicare does not cover, and for maintenance visits once they have signed a notice. An attorney gets an itemized lien statement while a car accident case is open. Chiropractic invoicing software creates each of these from charges already on the ledger, so nothing is keyed twice. Invoices go out by email or text with a secure link, and payments by card post back to the right account. Recurring plan invoices can run against a card on file. Because every invoice draws on one ledger, the patient's insured, cash and lien balances stay separate but in one place.

Why Is Invoicing Different in Chiropractic?

Cash plans are common in chiropractic and are easy to lose track of. Plans may be monthly, prepaid by the block, or priced per family. Each one needs its own invoice schedule, visit count and renewal date. Run from a spreadsheet, plans drift from the ledger, members are billed for visits they did not use, and renewals are missed. Invoicing for plans has to sit on the same ledger as the visits themselves.

Medicare patients bring their own invoicing rules. Exams, x-rays and therapy by a chiropractor are not Medicare benefits, so the patient pays for them. Maintenance visits can be billed to the patient only with a signed advance notice on file. Chiropractors may not opt out of Medicare, so covered active care is still billed to Medicare, not invoiced as a private arrangement. Each Medicare invoice has to match one of these cases.

Car accident cases add a third party. While the claim is open, the practice may hold the patient's balance under a lien or a letter of protection, as state law allows. The attorney needs itemized balances, and at settlement the practice may accept a reduced amount. Invoicing has to track what is owed, by whom, and what was finally paid, without sending the patient a bill they are not meant to get yet.

What Chiropractic Invoicing Software Handles

Self-pay invoices that match the estimate

Patients not using insurance are owed a good faith estimate of expected charges when they ask or book ahead. Self-pay invoicing draws on the same prices as the estimate, so the bill and the estimate line up. (CMS: What is a good faith estimate?)

Maintenance visits with a signed ABN

A signed notice lets the practice bill a Medicare patient if Medicare denies maintenance care. Invoices for those visits are created only when the notice is on the record and the denial is back. (CMS MLN Booklet: Medicare Advance Written Notices of Non-coverage (MLN006266))

Medicare-excluded services

Noridian lists x-rays, office visits and physical therapies by a chiropractor among the services beneficiaries pay for. Those charges go on the patient's invoice, apart from any CMT claim for the same visit. (Noridian JF Part B: Chiropractic Services (excluded services and GP/GY billing))

No private contracts for covered care

Chiropractors may not opt out of Medicare and provide services under private contract. Covered active care for a Medicare patient is billed to Medicare, so staff keep that care out of cash plans and off patient invoices. (CMS Medicare Benefit Policy Manual, Chapter 15, Section 240: Chiropractic Services)

Lien balances on accident cases

CMS notes that a practice may keep a claim or lien against a liability settlement once the Medicare timely filing period has lapsed. Lien balances are invoiced to the attorney on the case and held from the patient's statements. (CMS MLN Booklet: Medicare Secondary Payer (MLN006903))

Medicare Advantage members

Advance notices of non-coverage apply to fee-for-service patients. For Medicare Advantage members, staff follow the plan's own rules on patient liability before invoicing for a denied visit. (CMS MLN Booklet: Medicare Advance Written Notices of Non-coverage (MLN006266))

How Does Chiropractic Invoicing Software Work?

1. 1. Set up plans and price lists

   The practice sets its cash plans, visit blocks and self-pay prices. Each plan has its own invoice schedule and visit count.

2. 2. Create invoices from the ledger

   Charges marked for invoicing, such as plan fees, self-pay visits and excluded services, become invoices. They never go on a claim, and each self-pay invoice uses the practice's posted prices.

3. 3. Send by email or text

   Invoices go out with a secure link. Recurring plan invoices can charge a card on file, and payments post through chiropractic integrated payments.

4. 4. Invoice attorneys on lien cases

   Lien balances are itemized for the attorney on the injury case, and the patient's own statements are held while the case is open. Third-party liability details sit on the case.

5. 5. Settle and close

   When a case settles or a plan ends, the final payment and any write-off are posted. The patient's balance then moves to chiropractic patient billing if anything is left.

Chiropractic Invoicing Software vs. Generic Software

Who Uses It in a Chiropractic Practice

• Office manager: One place to run plans, self-pay visits and lien balances, with invoicing that follows the same ledger as claims.
• Front desk: Plan balances and what each patient owes at check-in, with no separate spreadsheet to check.
• Practice owner: A clear view of plan revenue, self-pay collections and money held on liens, apart from insurance income.