How to Improve Your Chiropractic Collections at the Front Desk


In today’s economy and health care marketplace, chiropractic offices frequently face challenges when collecting co-pays, deductibles, co-insurances and other balances due from patients. Unfortunately, ignoring the problem only makes it worse. Learn how to set up some simple systems for collecting the right way, every time from your chiropractic patients.

It used to be that if you failed to collect money from patients, that you either lost out on income and/or created collections issues for yourself. Asking for money is now an absolute necessity for two reasons: 1) lost income and 2) failure to ask for money that a patient owes the practice could lead to a breach of your chiropractic provider participation agreement as well as potentially creating a False Claim to the insurance carriers.

Unfortunately, in the 80’s, many chiropractors created a monster in that we allowed patients believe that their coinsurance was optional. I don’t personally know any clinics that are still stupid enough to engage in this practice; however, the stigma still exists.

To make collecting even more challenging, some patients believe that you, the chiropractor, make enough money and that you do not need the extra $20 or $30 bucks. They claim financial hardship and proceed to drive off in their Lexus, while you are so undercapitalized that you give your practices loans to make payroll.

You want another laugh? Many MD’s over the past few years have sought other ways to make up for lost revenues by adding ancillary services to their service mix. Take, for example, the Obstetrics and Gynecological practice that now offers weight management, laser hair removal or skin resurfacing. Interestingly enough, these services are paid in cash, in advance, before the services is even rendered.

What’s worse is that some of the very same patients who are lined up to pay cash for these cosmetic services (which usually total in the hundreds or thousands of dollars) are the same patients who gripe and complain when it comes to paying their $20 coinsurance or their $250 deductible.

Certainly, I am not stating that there are not financial hardships. When you run across a chiropractic patient with a legitimate financial issue on hand, you should have written policies in place to handle that. What I AM trying to convey is to eliminate excuses that patients use for non-payment. In short, be very cautious about allowing your patients to dictate how you run your practice.

Doctor (and staff), Heal Thyself
Sometimes, we (and our staff) are the biggest threat to good collections.

Ever watch your Chiropractic Assistant try to collect a co-pay? I have some seen some staff members ask a patient to pay their co-payment and literally duck as soon as the words come out of their mouth so as not to be hit by a thrown object! Bad sign, my friend. Get that person away from the front desk.

Another common problem is the attitude we use when collecting patient copayments. What do you think happens when your staff says to the patient “Would you like to pay now or should we bill you? What on earth do you think they are going to say? “By all means, bill me!” Don’t blame the patient. It’s the attitude of your staff that is the issue – they are acting like payments are optional. Train this person quickly or liberate them to find another job.

The Biggest Collection Problem in the Chiropractic Practice
Where does the biggest source of collections problem typically lurk in our practices? The Doctors — of course! What do most of us say when a patient gripes or complains to them about what they are having to pay out of pocket to come and see them? “Don’t worry about it, I’ll handle it!

If we heard one of our staff members say this, we would go ballistic; yet these very words spew out of our mouths frequently when it comes time to discuss money!

ReceptionistsThe Golden Rule for Collections
Ok, here is Tom Necela’s “Golden Rule” regarding collections, you ready for this? Get your highlighters and pens ready because this is the pay-off for the entire article. Ready? Are you sure? Last chance to get the highlighter!

Here it goes, “Never let the doctor get involved with a patient face to face or on the phone over finances.” Period. The end!

Doc, this is the beginning of the end for good collections procedures. When the chiropractor gets involved, it forever alters the physician/patient relationship and you can never get that back. In addition, this is where your billing manager and your staff — who are charged with the responsibility of collecting from the patients — get permanently discredited.

Yes, I said permanently. Why? You tell me, doc! If your well-trained staff tries to collect and YOU let the patient slide one time — what’s to prevent them from repeating the same behavior in the future?! Don’t do it. Train your staff well, train them often, give them consequences for non-performance and performance based bonuses.

And then, let them do their job!

Chiropractic Soup Nazi Beware!
Now, I know there are those of you out there who say, “Not in my practice Cowboy!” We collect from EVERYONE! Although this is typically less of a problem, I do have to address the other “extreme” of collections.

I do believe there are offices that are a little too efficient at collections. There is also a problem with this. I have seen how some of your staff handle your patients collections and they are like Seinfeld’s famed “Soup Nazi” — no soup for you!

You have what I refer to as the “bull dog” sitting at the check out area and when a patient tries to leave without paying their portion they attack like a dog going after a piece of raw meat! You know the type, they will literally wrestle the patient to the floor before letting them slide on a payment.

I once was at a chiropractic clinic where I literally watched in amazement as an incredibly rude, mean, and just plain scary front desk C.A. frightened patients into paying. She was totally consistent, but the vibe was way wrong. In fact, one of the patients in the waiting room witnessed her behavior and joked: “These docs must be making a lot of money. They got a bodyguard at the front desk to protect them!”

Yes, these offices get the money, but it’s bad for business, folks.

Find Happiness in the Middle
In short, collect everything you can. Give patients many possible ways to pay. Do this all while being nice about it and they will pay you.

Tom Necela, DC, CPC is the President of The Strategic Chiropractor, a consulting firm dedicated to helping chiropractors maximize reimbursements and minimize their risk of audits by teaching sound billing, coding, documentation and collections strategies. If you’d like more information about Dr. Necela’s consulting programs (which include a Documentation Self-Audit), go to