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Summary: A selection guide for chiropractors choosing a billing company. Includes a weighted scorecard and calculator to compare up to three vendors, chiropractic and Medicare tests to run on any biller, red flags, a contract checklist, interview questions, how SPRY's optional RCM service is priced, and FAQs.
Choose a chiropractic billing company by scoring each candidate on the same criteria: chiropractic coding skill, whether they work inside your data, reporting, compliance, fees and contract exit terms, and references from similar practices. Test coding skill with a real claim, not a sales pitch, and get fees and data-return terms in writing.
This guide gives you a weighted scorecard and calculator, the chiropractic and Medicare tests to run on any biller, red flags, a contract checklist and interview questions. For what billing services cost and how they compare, see chiropractic billing services: costs and options, and for software-led billing see chiropractic RCM services.
The selection scorecard: six criteria that matter
| Criterion | Suggested weight | What to look for | How to test it |
|---|---|---|---|
| Chiropractic expertise | 25 | Fluency in CMT codes 98940 to 98942, the AT modifier, documentation and Medicare rules | Hand them a de-identified claim and ask what they would report and why |
| Technology and integration | 20 | Works inside your EHR or practice management data, or in one platform with it | Ask for a live demo using your workflow, not slides |
| Performance and reporting | 20 | Clean claim rate, days in A/R and denial reasons reported by payer | Ask for a sample monthly report and how each metric is defined |
| Cost and contract terms | 15 | Every fee itemized, with exit terms and data return in writing | Ask for the full fee schedule and the termination clause before signing |
| Compliance | 10 | Signed business associate agreement, audit support, staff training | Ask who answers a payer audit request and how fast |
| Service and communication | 10 | Named contact, response times, escalation path | Call the reference clients and ask how problems were handled |
The weights are a starting point. A practice with heavy Medicare volume might weight compliance higher, and a multi-provider group might weight reporting higher. Change them in the calculator below.
Billing company scorecard calculator
Compare up to three billing companies
Score each vendor from 0 to 10 on each criterion using what you learn in demos and reference calls. Weights are editable and do not need to add up to 100.
| Criterion | Weight | Vendor A | Vendor B | Vendor C |
|---|---|---|---|---|
| Chiropractic expertise | ||||
| Technology and integration | ||||
| Performance and reporting | ||||
| Cost and contract terms | ||||
| Compliance | ||||
| Service and communication |
| Vendor | Weighted score (out of 100) |
|---|
A scoring aid built from your own ratings. It does not rank real companies, and a high score does not replace reference checks and a contract review.
Chiropractic and Medicare tests to run on any biller
A billing company that serves several specialties can still do chiropractic well, but only if it can answer the questions below without hesitation. Ask them in the interview, and check the answers against the sources.
| Test | What a good answer includes | Source |
|---|---|---|
| What does Medicare cover? | Part B covers only spinal adjustments by hand or with an activator device to correct subluxation. X-rays, massage therapy and acupuncture ordered by the chiropractor are not covered, and the patient pays 20% after the deductible | Medicare.gov |
| How do you report CMT codes? | 98940 to 98942 are not add-on codes, so only the highest-level code is reported for a date of service | First Coast Service Options code guide on the CMS Medicare Coverage Database |
| When is the AT modifier used? | AT identifies active treatment and is not used on maintenance care; GA, GX, GY and GZ relate to the Advance Beneficiary Notice (ABN), covering required notices, voluntary notices, statutorily excluded services and no notice, respectively | First Coast Service Options code guide on the CMS Medicare Coverage Database and CGS Medicare |
| What is the Medicare filing deadline? | Fee-for-service claims must be filed within 12 months of the date of service, and denials for late filing generally cannot be appealed | CMS |
| How do you handle audits? | Names who responds, how documentation is gathered and what turnaround to expect. An OIG report OEI-01-14-00200 (September 2015) found $76 million in questionable Medicare payments for chiropractic services in 2013, so audit readiness is worth testing | HHS OIG |
Red flags when choosing a billing company
| Red flag | Why it matters | What to do |
|---|---|---|
| Guaranteed collection increases | No one controls payer behavior or your documentation quality | Ask for the metrics they report and how they are defined instead of a promise |
| A percentage fee with no itemized extras | Setup, statement, appeal and credentialing fees can change the real cost | Request the full fee schedule in writing |
| No business associate agreement offered | A billing company handles protected health information; HIPAA requires a written agreement | Do not share patient data until it is signed |
| Work happens in a system you cannot see | You cannot check claim status or denials yourself | Require access to claim status and denial reports |
| Long auto-renewing contract with no exit terms | You may not be able to leave or get your data back | Negotiate termination rights and data return |
| No named staff or reference clients | You cannot verify who does the work | Ask for a named contact and two references from similar practices |
Under HIPAA, a company that does billing for you is a business associate, and the covered entity needs a written agreement before sharing protected health information. See HHS business associate guidance.
Contract checklist before you sign
- Fees: percentage or flat fee, plus every extra, with how they are calculated.
- Term and exit: length, renewal, notice period and how data and payer enrollment records are returned if you leave.
- Business associate agreement: signed and covering breach notification and data return or destruction.
- Service levels: turnaround for claims, denial follow-up and reporting, with remedies if missed.
- Liability: who is responsible for errors, and whether the company carries coverage for billing mistakes.
- Ownership: your payer contracts, credentialing records and patient data stay yours.
Switching without disrupting cash flow
Before the switch, record your current baseline for days in A/R, clean claim rate and denial reasons so you can judge the new company fairly. Ask for a transition plan with dates, and consider running one billing cycle in parallel so claims are checked before the old process stops. Keep working through any open claims from the previous process rather than leaving them behind.
How SPRY fits
SPRY offers chiropractic software and an optional RCM and billing service. Per its pricing page, the service is 4% to 6% of collections, based on total number of billable appointments, and includes credentialing, a bulk eligibility verification dashboard, prior authorization, integrated payments, denial management, advanced claim scrubbing, MIPS reporting, patient communication and payment follow-up. Data migration is listed as possible in as few as 30 days.
On its chiropractic page SPRY states 40% fewer denials, and on its RCM page 95%+ clean claims on first submission, 24 to 48 hour denial resolution, under 7 days in A/R and 97%+ eligibility accuracy. These are SPRY's own figures, so ask in a demo how each is defined and measured. Apply the scorecard above to SPRY the same way you would to anyone else. See SPRY for chiropractic or book a demo.
Related reading: the ultimate guide to chiropractic billing, chiropractic billing services, chiropractic RCM services, how to outsource orthopedic billing and HIPAA compliance for practices.
Frequently asked questions
How does a chiropractor find a reliable billing service?
Shortlist companies that serve chiropractors, give each the same test claim, score them on the same criteria and call references from practices like yours. Get fees, exit terms and a business associate agreement in writing before signing.
What should a chiropractic billing company charge?
Many billing companies charge a percentage of collections, and some add setup, statement or appeal fees, so ask for an itemized schedule. SPRY's published range for its optional RCM service is 4% to 6% of collections. See our guide to chiropractic billing service costs for published prices.
What questions should I ask a chiropractic billing company?
Who does the work and in which system, how they report CMT codes and the AT modifier, what reports you will see, how they handle audits, what every fee is and how you can leave and take your data.
Do I need a business associate agreement with my billing company?
Yes. HHS lists billing as a business associate function, and a covered entity must have a written agreement before disclosing protected health information to one.
How do I read billing company reviews?
Treat reviews as a starting point. Look for details about denials, communication and fees, and confirm with reference calls from practices of your size and payer mix. Review sites mostly cover software, so verify services directly.
Should my billing company use the same system as my EHR?
One platform for documentation and billing removes re-entry and keeps claim data tied to the note. If the biller works in a separate system, ask how data moves and who is accountable when something breaks.
How long does it take to switch billing companies?
It depends on the vendor and your payer set-up. SPRY lists data migration in as few as 30 days. Ask any vendor for a dated transition plan and consider a parallel billing cycle.
Is outsourcing chiropractic billing worth it?
It can be if billing is taking staff time or claims are aging, but compare the fee against your in-house cost and your denial and A/R results. Our chiropractic billing services guide includes a calculator for the comparison.
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Get a DemoLegal Disclosure:- Comparative information presented reflects our records as of Nov 2025. Product features, pricing, and availability for both our products and competitors' offerings may change over time. Statements about competitors are based on publicly available information, market research, and customer feedback; supporting documentation and sources are available upon request. Performance metrics and customer outcomes represent reported experiences that may vary based on facility configuration, existing workflows, staff adoption, and payer mix. We recommend conducting your own due diligence and verifying current features, pricing, and capabilities directly with each vendor when making software evaluation decisions. This content is for informational purposes only and does not constitute legal, financial, or business advice.
