Chiropractic Payment Posting Software

Payment Posting in a Chiropractic Practice

A chiropractic office posts a lot of small payments. A patient on an active care plan may come in several times a week, and each visit brings a copay and a claim. Unlimited Systems imports each 835 remittance and matches it to the claim line by line. For Medicare, the manipulation line billed with the AT modifier posts as paid. A maintenance visit billed with GA posts as a denial the patient owes, since an ABN was signed. Exams, x-rays and therapy that a chiropractor bills with GY also move to the patient, because Medicare does not cover them from a chiropractor. A missing initial treatment date comes back as a fixable error, not a write-off. Auto and workers' compensation carriers often pay by paper check, and staff post those checks against the case's claim number. Copays taken at the front desk land on the same ledger, and each day's totals are matched to deposits.

Why Is Payment Posting Different in Chiropractic?

Volume is the first difference. Chiropractic care runs on frequent, short visits under a treatment plan. That means many claims with small paid amounts, and a copay on almost every visit. A payment posting process built for fewer, larger claims gets buried here. Each copay must reach the right date of service, or the patient's balance stops matching what the front desk collected.

Medicare adds its own logic. It pays a chiropractor only for manual manipulation of the spine to correct a subluxation, billed as 98940, 98941 or 98942 with the AT modifier. A visit without AT is treated as maintenance and denied. Other services a chiropractor bills, such as exams and x-rays, are not covered at all. So one Medicare remittance can carry a paid line, a GA denial the patient owes, and excluded lines that also go to the patient. Each one needs a different posting action.

Then come accident and injury cases. Auto no-fault, liability and workers' compensation carriers pay first when an injury is theirs, and health plans deny with codes that say so. Many of these carriers still mail paper checks and EOBs. Posting has to keep each case's money with the case, so open accident balances can be worked and the health plan is not billed by mistake.

What Chiropractic Payment Posting Software Handles

AT modifier on 98940, 98941 and 98942

Medicare pays these manipulation codes only for active or corrective care billed with AT. Paid AT lines post as usual, and an AT line denied after medical review goes to follow-up with its reason code. (CMS Medicare Benefit Policy Manual, Chapter 15, Section 240 (Chiropractic Services))

GA and GZ maintenance lines

A GA line means an ABN was signed, so a maintenance denial posts as patient responsibility. A GZ line means no ABN was signed, so the denial stays with the practice and is held for review before any write-off. (Noridian JE Part B: Chiropractic Claim Submission Requirements (AT, GA, GZ, GY))

GY on excluded services

Exams, x-rays and therapy that a chiropractor bills to Medicare carry GY and are denied as excluded. The poster moves those lines to the patient under the practice's financial policy. (Noridian JE Part B: Chiropractic Claim Submission Requirements (AT, GA, GZ, GY))

CARC 16 with RARC MA122

Medicare uses this pair when the initial treatment or exacerbation date is missing. The line goes to a correction queue so the date can be added and the claim sent again. (CMS Medicare Claims Processing Manual, Chapter 12, Section 220 (Chiropractic Services))

CARC 119 visit-limit denials

This code says the benefit maximum was reached. Staff check the visit count against the plan before billing the patient or appealing a limit applied too early. (X12 Claim Adjustment Reason Codes)

CARC 19, 20 and 21

These codes say a workers' compensation, liability or no-fault carrier is liable. The denied line stays open and is moved to that carrier instead of being written off. (X12 Claim Adjustment Reason Codes)

97140 bundled with manipulation

Under NCCI, manual therapy in the same spinal region as manipulation is not paid on its own. A bundling denial is flagged so staff can check whether the note shows a different region before resubmitting with 59 or XS. (CMS NCCI Policy Manual for Medicare Services, Chapter XI, Section S (Chiropractic Manipulative Treatment))

How Does Chiropractic Payment Posting Software Work?

1. 1. Import remittances

   835 files from Medicare and health plans are imported as they arrive. Each file is matched to its original claim and claim line.

2. 2. Post each line

   Each CPT line gets its own paid amount, contractual adjustment and patient share. A paid manipulation line and a denied exam line from the same visit are posted on their own.

3. 3. Route the exceptions

   Denials are sorted by reason code into queues. Missing-date errors go to correction, visit-limit denials go to review, and wrong-payer codes go to the staff who handle accident claims.

4. 4. Post paper checks by case

   Auto and workers' compensation checks are posted against the case and its carrier claim number. Accident money stays with the accident case, not the patient's health plan account.

5. 5. Apply copays and plan payments

   Copays, self-pay visits and care-plan installments post to the same ledger. Whatever is left moves on to patient statements.

6. 6. Reconcile to the bank

   Each day's posted totals are matched to bank deposits, EFTs and lockbox files. Cash, adjustments and recoveries then flow to the general ledger as balanced entries.

Chiropractic Payment Posting Software vs. Generic Software

Who Uses It in a Chiropractic Practice

• Payment poster: A queue of only the lines that did not post cleanly, with GA, GY, CARC 16 and CARC 119 lines already sorted by next step.
• Billing manager: Denials by payer and reason, so a run of missing initial treatment dates or visit-limit problems gets fixed before the next claim goes out.
• Clinic owner: Cash that ties to the bank, and a ledger that shows health plan, Medicare, accident and self-pay money apart.