ARTICLE
Note: TCA’s Insurance Relations Committee will contribute a monthly article to eSource. Got an insurance or compliance question? Email the TCA office at info@chirotexas.org. By Kelli Moore, MCS-P, I Medical Compliance Specialist Physician Instructor After nearly 30 years handling chiropractic billing, coding, documentation, and compliance, I’ve seen the profession change dramatically — and not always for the better. A routine spinal adjustment that takes just 5-10 minutes of skilled hands-on work is now reimbursed in the low $20s by major payers like BCBSTX following recent fee schedule cuts. At the same time, those same payers demand extensive, visit-specific SOAP notes complete with functional goals, compliance tracking, medical necessity justification, and a clear distinction between active care and maintenance. Adding to the frustration, many patients treat their annual visit allowance like a personal “bucket,” coming in only when they hurt. This reactive approach leads to repeated exacerbations, fragmented care, and prolonged episodes. The result? Practices must see more patients per day just to stay afloat, documentation often gets shortchanged, and audits can make even good care look like maintenance on paper. The administrative burden creates thin margins, overload, audit vulnerability, and burnout for dedicated practitioners trying to run a sustainable business. This isn’t just frustrating — it’s unsustainable. Healthcare is a business, and the current model is squeezing small practices to the breaking point. Key Challenges Thin Margins: Reimbursements no longer cover time, overhead, and required paperwork. Documentation Burden: Detailed notes for every visit eat into productive time. Patient Mindset: Reactive “use it when it hurts” behavior creates inefficiency and recurring issues. Audit Risk: Inadequate records on necessity or discharge turn good care into financial liability. Simple, Practical Steps to Overcome These Hurdles 1. Master Efficient, Defensible Documentation Use smart templates or EHR macros for consistency, while customizing the Assessment and Plan. Example language for a non-compliant/prolonged episode: Assessment: “Recurrent exacerbation due to inconsistent HEP adherence; patient has not achieved maximum therapeutic benefit. Functional limitations persist.” Plan: “Reinforced treatment plan and HEP; patient demonstrated proper form. Goal: Improve adherence and reduce flare-ups within 2 weeks. 2. Set Strong Treatment Plans and Expectations Upfront Create measurable, goal-oriented plans with patient buy-in. Educate from day one about the difference between active care and maintenance. 3. Address Non-Compliance and Prolonged Episodes Directly Document gaps factually and update plans. Example for return after gap: Subjective: “Returns after 6-week gap with recurrence of pain; admits inconsistent home exercises.” Assessment: “Regression secondary to non-compliance; continued skilled care medically necessary to break cycle.” 4. Optimize Operations and Diversify Revenue Leverage technology for faster charting, negotiate contracts, and offer clearly separated cash-pay wellness options. 5. Know When — and How — to Release to Self-Management Formalize discharge with clear language. Example: Assessment: “Patient has met functional goals with resolution of symptoms and restored ROM. Maximum therapeutic benefit reached.” Plan: “Discharge to self-management with HEP; return PRN for exacerbations.” Why These Steps Are Essential Implementing these practices isn’t optional — it’s how you protect your livelihood in a challenging reimbursement environment. Strong documentation turns potential denials and audits into paid claims. Clear patient communication and efficient processes reduce wasted visits and build loyalty. By treating compliance and business operations as core clinical skills, you safeguard your practice’s financial health, maintain high-quality care, and position yourself to thrive despite payer pressures. The doctors who adapt with these strategies aren’t just surviving — they’re leading sustainable, audit-resistant practices that put patients first while staying profitable. The alternative is watching margins disappear one low-reimbursement visit at a time. Kelli Moore, MCSP-I, is a retired chiropractic healthcare professional with over 30 years of experience. She has worked in every facet of practice operations—from front desk and patient therapy to practice management—while co-owning and operating five clinics with her chiropractor husband. Certified as a Medical Compliance Specialist (Physician), she became an instructor and consultant specializing in compliance plans, documentation, coding, billing, and practice management. In 2014, Parker University named her Chiropractic Assistant of the Year. Kelli also partnered with software companies to create efficient, compliant tools and taught popular courses for state chiropractic associations using her motto: “Be Prepared, Not Scared.”