How to Charge Patients in a Chiropractic Cash Practice

4 Minute Read Time
January 4, 2024

Dealing with insurance companies and Medicare requirements can be a challenge, and that’s putting it mildly. Today, more chiropractors are considering switching to a cash practice to reduce their headaches and better control their cash flow. At a chiropractic cash practice, the chiropractors have more control over fees and payments. It enables the focus to remain on client care rather than on what insurance will pay for (or when it will pay for it). It also reduces paperwork and alleviates the need to get insurance verification.

Moving to a Cash Practice: What You Need

There are a few things that you need to do and strategies to take before charging patients in a chiropractic cash practice.

Financial Responsibility Policy

Ensure that you have a written policy on financial responsibility and that it has passed legal inspection by your legal counsel.

This policy will need to be included during every new patient intake and provided to current patients informing them of your cash payment requirements.

Staff Training

You need to provide training for your front-desk personnel on collections and policies. Besides knowing the policy well, they should be able to provide clear communication and explain the changes to patients.

When you’re responsible for collections rather than submitting to an insurance carrier, you’ll be collecting more payments from patients. Staff should be trained on how to deal with excuses for nonpayment and potentially unhappy patients.

Patients with Insurance

Moving to cash practice doesn’t mean patients can’t use their insurance. They will simply have to pay you in full and then file their claims themselves. You and your staff will also want to understand insurance requirements for reimbursement, as some insurance policies mandate direct billing from providers.

Bill Preparation

Not all the paperwork burdens will go away upon switching to a cash practice. You will still need proper coding and documentation for patients who need to submit claims to their insurance carrier.

Also, patients have the right to request their records, so you will need to continue all your documentation. You should be prepared for some patients to leave your practice, whether it’s because they don’t want to deal with the hassle of submitting claims or you can’t meet their documentation needs.

Integrated Billing System

You will need an integrated billing system that automatically posts payments to the patient’s ledgers, stores credit cards securely, and processes recurring payments. An integrated billing system, such as the one included with ChiroSpring, is essential for seamless payment and collection in a cash practice.

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How to Charge Patients in a Chiropractic Cash Practice

You may want to change how you charge patients in a chiropractic cash practice, but you do need to be aware of the laws.


Offering discounts for cash patients may be a good way to encourage patients to pay promptly and accept the change to the chiropractic practice. However, depending on how it’s done, discounts may be seen as an inducement and may cause legal trouble. You will need to check with the state board and your healthcare attorney before offering discounts.

Avoiding Dual Fees

You need to avoid a “dual fee” schedule, such as offering one price for patients who are paying cash and another for those submitting for reimbursement. It’s bad practice and may be illegal.

Online and Electronic Payments

The more that you can move payments to electronic, the better your practice will be. Handling physical cash is messy and can be prone to leakage. Taking card payments in the office is easier. By allowing online payments, you also make it simple for patients to pay their bills.

Using a system that enables recurring payments, such as progress payments during a treatment plan, is a good idea. The less often that patients have to think about paying for treatment, the better. Autopay or flat monthly payments can help reduce collections and provide a more consistent cash flow.

Developing Loyalty

The key to successfully transitioning to a cash practice is developing loyalty with patients. It can cost six to seven times more to find new patients, so creating a loyal core of patients who return for care is crucial for growing your practice.

How you charge patients in a chiropractic cash practice can help enhance that loyalty. Developing a formal care plan that lays out a roadmap for treatment helps motivate patients to keep coming back. At each visit, you need to demonstrate the value of the care and provide feedback so patients can see the progress that’s been made.


It’s not an all-or-nothing situation. Many cash-only chiropractors still accept Medicare patients. That’s a choice that you will need to make. However, Medicare does require submission to come directly from providers for in-network charges, so you will need to provide the appropriate paperwork and billing.

An Easier Way to Manage Your Cash Chiropractic Practice

ChiroSpring makes all this possible with comprehensive EHR practice management software that saves you time, reduces your costs, and helps increase your profits. From online scheduling and intake to SOAP notes, billing, reconciliation, assessments, care plans, and integrated payments, ChiroSpring simplifies administrative tasks and keeps your practice running smoothly.

ChiroSpring is an all-in-one practice management and EHR system built specifically for chiropractors to help them regain face-time with patients, spend less time on back-office tasks, maintain a limited staff, and save operational costs.

To see how ChiroSpring can help you simplify how you manage your practice, reach out to one of our specialists today!

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