How to Prepare Your Practice for Year-End Billing in 2025

Year-end billing is a critical time for chiropractic and physical therapy practices to close out financial records, reconcile claims, and set the stage for a strong start in 2026. With Medicare’s 2025 rules, including new CPT codes and stricter compliance requirements, preparing effectively ensures you maximize revenue and avoid costly errors. This article outlines key steps to wrap up your billing year, from reviewing claims to updating patient accounts, while staying compliant with regulations. Practice management tools can simplify these tasks, but the focus is on practical strategies to keep your practice financially healthy.

Why Year-End Billing Preparation Matters

Year-end billing ensures all claims are submitted, payments are collected, and records are audit-ready before the new year. Missing deadlines or overlooking errors can lead to lost revenue, denials, or compliance issues. In 2025, Medicare’s 2.8% payment cut for chiropractic codes (98940–98942) and prior authorization requirements for PT services (e.g., 97140) make it essential to close out the year correctly. Proper preparation improves cash flow, reduces administrative stress, and positions your practice for success in 2026.

Key Steps for Year-End Billing Preparation

To prepare for year-end billing, focus on reconciling claims, updating patient accounts, verifying compliance, and planning for 2026.

1. Reconcile Outstanding Claims

Unsubmitted or unpaid claims can cost your practice thousands if not addressed before year-end.

• Review Unsubmitted Claims: Check for claims not yet filed, ensuring they meet Medicare’s 12-month submission deadline (e.g., claims from January 2025 must be submitted by December 31, 2025).
• Track Payments: Verify payments received match services billed, using Medicare Summary Notices or Explanation of Benefits (EOB).
• Appeal Denials: File redetermination requests for denied claims within 120 days, including documentation like P.A.R.T. criteria for chiropractors or time logs for PTs.

2. Update Patient Accounts

Accurate patient accounts prevent billing disputes and ensure timely collections.

• Review Balances: Identify outstanding patient balances, like copays or deductibles, and send reminders or statements.
• Verify Insurance: Confirm 2025 coverage for returning patients, checking for changes in Medicare Part B or private plans effective January 2026.
• Clear Old Accounts: Resolve accounts over 90 days old, offering payment plans if needed to avoid write-offs.

3. Ensure Compliance with 2025 Rules

Year-end is the time to audit records for compliance with Medicare’s 2025 requirements.

• Chiropractors: Verify P.A.R.T. criteria (Pain, Asymmetry, Range of motion, Tissue tone) for 98940–98942 claims, e.g., “Cervical pain, reduced motion, asymmetry noted.” Ensure AT modifiers are included.
• Physical Therapists: Check time logs for 97110 or 97140, like “10:00–10:15 AM,” and confirm prior authorizations for high-cost services (over $3,000 annually).
• Tip: Conduct a self-audit of 10–20 claims to catch errors like missing modifiers or vague notes.

4. Submit MIPS Data

MIPS reporting impacts 2027 payments by up to 9% based on 2025 performance.

• Eligibility: Report if you bill over $90,000 in Medicare Part B, treat 200+ patients, or provide 200+ services.
• Quality Measures: Submit data for measures like “Pain Assessment” for chiropractors or “Functional Status” for PTs via a certified EHR or registry.
• Deadline: Submit 2025 MIPS data by March 31, 2026, but prepare data by year-end to avoid last-minute errors.

5. Plan for 2026 Compliance

Use year-end to prepare for upcoming changes and streamline processes.

• Review Updates: Study projected 2026 Medicare changes, like potential CPT code updates or MIPS threshold adjustments, using CMS.gov.
• Update Templates: Revise documentation templates for P.A.R.T. criteria, SOAP notes, or PT time logs to reflect 2026 requirements.
• Train Staff: Schedule training on new codes or compliance rules to start 2026 strong.

Common Year-End Billing Mistakes to Avoid

These errors can disrupt your year-end process:

• Missing Submission Deadlines: Failing to file claims within Medicare’s 12-month window loses revenue.
• Incomplete Documentation: Vague notes, like “Did adjustment,” don’t support claims during audits.
• Ignoring Denials: Not appealing denials within 120 days forfeits payments.
• Outdated Patient Records: Incorrect insurance or contact information delays collections.
• Skipping MIPS: Missing MIPS reporting risks a 9% payment cut in 2027.

Best Practices for Year-End Billing

Follow these steps to close out 2025 effectively:

1. Audit Claims: Review all 2025 claims for accuracy, ensuring codes (e.g., 98940, 97110) and modifiers (e.g., AT) are correct.
2. Reconcile Payments: Match payments to claims, resolving discrepancies with payers.
3. Update Accounts: Send patient statements and verify 2026 insurance coverage.
4. Conduct Compliance Checks: Audit documentation for P.A.R.T. criteria, time logs, and authorizations.
5. Prepare MIPS Data: Compile quality measure data for submission by March 31, 2026.
6. Use Technology: Leverage software to track claims and flag errors. Tools like Billing Dynamix can help, but any system works.
7. Plan Ahead: Schedule staff training and update processes for 2026 compliance.

Benefits of Effective Year-End Preparation

Proper year-end billing offers these advantages:

• Higher Revenue: Resolving claims and denials recovers $500–$1,000 monthly for a practice with 50 claims.
• Improved Cash Flow: Timely submissions and collections boost funds for 2026.
• Lower Audit Risk: Compliant records reduce Medicare scrutiny.
• Smoother Operations: Organized accounts reduce administrative stress.
• Better Patient Trust: Clear billing enhances satisfaction.

Tools to Support Year-End Billing

Practice management software can automate claim tracking, patient account updates, and compliance checks. Systems like Billing Dynamix simplify these tasks, but any reliable tool can help. The key is to use technology to ensure accuracy and efficiency during year-end.

Conclusion

Preparing for year-end billing in 2025 is essential for chiropractic and physical therapy practices to maximize revenue and stay compliant. By reconciling claims, updating accounts, and planning for 2026, you can close out the year successfully. Use these strategies and reliable tools to ensure your practice starts the new year financially strong.

Sources

• Centers for Medicare & Medicaid Services (CMS). (2024). Medicare Claims Processing Manual. Retrieved from cms.gov.
• American Chiropractic Association. (2024). Year-End Billing for Chiropractors. Retrieved from acatoday.org.
• American Physical Therapy Association (APTA). (2024). PT Year-End Billing Strategies. Retrieved from apta.org.
• American Medical Association (AMA). (2024). CPT 2025 Codebook. Retrieved from ama-assn.org.