Chiropractic Billing: Complying With The No Surprises Act - Chirotouch
January 17, 2023 by ChiroTouch Team Article Billing


  • The No Surprises Act (NSA) significantly impacts chiropractic billing for practices in the U.S. 
  • NSA provisions prohibit surprise billing for out-of-network services received by patients.
  • Staying compliant with NSA means giving patients easy-to-understand fee schedules and in-network versus out-of-network providers and services at your practice.
  • Cloud-based chiropractic EHR practice management software can help you comply with NSA rules through automated insurance processing and billing features.

The newly enacted No Surprises act applies to Chiropractors and prohibits healthcare providers from issuing surprise bills to patients who receive out-of-network services. As a chiropractor, you must remain compliant with the No Surprises Act guidelines to avoid federal penalties and causing financial harm to patients.

Implementing chiropractic billing and insurance operations, such as automated processing and transparent patient communication, can help you stay compliant with these new federal rules.

What Is the No Surprises Act?

The No Surprises Act (NSA) protects U.S. healthcare consumers from surprise medical billing. The NSA went into effect on January 1, 2022, and requires healthcare providers to follow several billing guidelines to prevent patients from receiving unexpected medical bills for out-of-network services.

In general, “surprise bills” refers to any bills a patient receives for which they were not given a reasonable estimate before agreeing to the treatment. According to the Kaiser Family Foundation (KFF), between 9% and 16% of people who visit the ER receive a surprise bill or higher-than-expected rates for extra services, such as an anesthetist, because an out-of-network provider performed those services.

The NSA covers the following requirements regarding provider billing:

Out-of-Network Claims and Cost Sharing

Per the NSA, health insurance plans must cover out-of-network claims through in-network cost-sharing for services received at an in-network facility.

Prohibitive Billing

The NSA prohibits all providers and hospitals from issuing surprise medical bills at a higher price than in-network cost-sharing.

Determination of Payment Amount

The NSA sets a dispute process to determine acceptable payment amounts for out-of-network claims. This determination starts with discussions between providers and healthcare plans, followed by an independent dispute resolution if they cannot reach an agreement.

Standard Waiver of Consent

Most healthcare providers must provide a standard waiver of consent form when providing out-of-network services. This document estimates the costs the patient may owe for their services, insurance billing codes, and a description of services.

Sliding-scale Fees

Providers who offer sliding-scale fees to uninsured or self-pay patients must provide a good faith estimate for their services. This good faith estimate must contain the following information:

  • Description of the service
  • Itemized list of services, according to the provider or facility
  • Diagnosis codes for the services
  • Expected cost of service
  • Additional charges associated with listed services

Expected Charges From Co-Providers

Under the NSA, co-providers and co-facilities that provide services adjacent to a primary service must provide a good faith estimate of associated costs. However, recent NSA updates acknowledge the difficulty of implementing an efficient system for co-care cost estimates, and CMS plans to update requirements as these guidelines are implemented.

chiropractic billing

No Surprises Act and Chiropractic Billing

NSA requirements have a significant impact on billing for chiropractic practices. The NSA protects patients who seek non-emergency services from healthcare providers, so you must adhere to policies outlined in the federal bill when a patient visits your practice.

Non-emergency services you may offer at your practice include chiropractic treatment, treatment provided with medical equipment, and lab or imaging services. If your practice does not adhere to NSA guidelines or bills more than the in-network amount to patients, the U.S. Department of Health and Human Services (HHS) may fine you up to $10,000 per violation.

Your chiropractic practice should focus on the following actions to prevent a misstep in NSA compliance:

Avoid Surprise Billing

As a healthcare professional, you must avoid giving your patients unexpected bills for your chiropractic services. There are several actions you can take to eliminate surprise bills, including:

  • Provide fee statements specific to each patient
  • Offer a fee statement, both written and verbally
  • Provide the cost of all services received or expected to receive
  • Make the fee statement accessible
  • Ensure the patient signs the document
  • Always include cost estimates for other providers in your practice
  • Include cost estimates for recurring services and the number of recommended sessions

Clearly Define In-Network vs. Out-of-Network Services and Providers

If you run a multi-provider chiropractic practice, you must define to your patients which providers are in-network versus out-of-network. For example, if you are in-network for a specific insurance carrier but another provider at your practice is out-of-network, you must clearly state this in patient communications.

If your patient sees the other provider when you are not available, they should know that their insurance won’t cover the same amount.

Process Claims Quickly

The NSA requires providers to process claims within an appropriate timeframe, and insurance companies must give notice of payment or denial within 30 days. Your practice must stay on top of insurance claims processing to ensure that you file claims quickly and efficiently so your patients aren’t met with a surprise bill several months after receiving care.

Communicate with Patients

The NSA intends to encourage providers to be open in communicating with patients about the cost of their healthcare services. It is essential that your practice engages with patients in an open, transparent fashion and delivers communications through multiple avenues, such as email, SMS text, and phone.

Put it in Writing and Keep Patient Records

Maintaining meticulous patient records regarding care received and billing can help you stay compliant with NSA rules. You can use a cloud-based chiropractic EHR and practice management system that allows you to store signed patient notices and any other documentation related to the explanation of costs.

You also want to keep all insurance processing and billing records to show you are following NSA guidelines.

typing on a laptop

Using Completely Integrated EHR Software to Solve Compliance Issues

Staying in compliance with NSA can be challenging, especially if your practice uses outdated EHR software or manual billing or insurance processing methods. By switching to completely integrated chiropractic billing software from ChiroTouch, you can minimize the risk of surprise billing and maintain compliance with NSA regulations.

Automated Insurance

Automated insurance features from ChiroTouch allow you to process insurance claims quickly through an automated clearinghouse. This lets you see payments and denials within days of a patient receiving services.

ChiroTouch Advanced users also have the ability to add CT Verify, a tool that checks insurance eligibility for patients with the click of a button. You can let them know their rates and cost estimates before they come in.

Automated Billing

ChiroTouch’s automated billing features let you post payments quickly, minimizing errors and delays. With ChiroTouch, you can easily send patient invoices and check balances to ensure there are no surprise bills for your patients.

Patient Communication Tools

With ChiroTouch, you have access to patient communication tools like CT Engage, which allow you to send your patients secure, HIPAA-compliant messages regarding their EOBs, billing statements, insurance claims, and other notices.

CT InForms, another ancillary tool from ChiroTouch, lets you easily create intake documents, such as NSA-compliant waivers and notices, and send them to patients to review and sign before coming in for their session.

Customizable forms and templates available with ChiroTouch can help your practice create good faith estimates for sliding-scale fees and co-provider fees per NSA policies. Once created, you can easily update the forms as costs or co-providers change, keeping you compliant with federal billing regulations.

Ensure Your Practice’s Chiropractic Billing Stays Compliant With ChiroTouch

Learn more about how ChiroTouch can help you stay compliant with the newly enacted No Surprises Act guidelines. Schedule your demo today and see what the cloud standard for chiropractors can do for your chiropractic practice.

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