Lost Revenue from Underutilizing Permitted Scope Due to Regulatory Uncertainty
Definition
Because state practice acts and board interpretations are complex and differ widely, many chiropractors avoid offering services that are actually permitted (e.g., certain diagnostics, orthotics, rehabilitation, physicals, lifestyle counseling) to stay ‘safe,’ resulting in systematic under‑billing and missed service lines. Studies documenting the broad scope in some states and the dynamic, ambiguous nature of statutes indicate that DCs often fail to capture reimbursable services they are legally allowed to provide.
Key Findings
- Financial Impact: $20,000–$150,000 in unrealized annual revenue per clinic, depending on patient volume and how many allowed services (e.g., imaging referrals, rehab codes, exam types) are not offered or billed.
- Frequency: Daily (each patient encounter where potential services are not offered or coded).
- Root Cause: High variability and ambiguity in scope-of-practice language across jurisdictions, coupled with a lack of internal legal/compliance expertise, leads DCs to adopt overly conservative, ‘lowest common denominator’ service menus. Many statutes explicitly allow a wide array of evaluations, diagnostics, orthotic and rehab services, but unclear board guidance and fear of discipline cause clinics to underuse these capabilities.
Why This Matters
This pain point represents a significant opportunity for B2B solutions targeting Chiropractors.
Affected Stakeholders
Clinic owners, Associate chiropractors, Billing and coding staff, Revenue cycle managers
Deep Analysis (Premium)
Financial Impact
$20,000–$150,000 annual unrealized revenue from auto claims with limited service mix • $20,000–$150,000 annual unrealized revenue from services provided but not billed • $20,000–$150,000 annual unrealized revenue from under-billed services
Current Workarounds
Conservative billing approach; manual state-by-state scope rules spreadsheet; practice manager sends email decisions to billing team; annual compliance review; phone calls to WC carrier • Conservative billing policy; manual service-to-code spreadsheets; practice manager makes final billing decisions via email or spreadsheet; reliance on annual compliance audits (reactive); informal communication with billing team about scope boundaries • Conservative clinical decision-making; avoiding services due to regulatory ambiguity; informal phone calls to state board; reliance on outdated scope interpretations; memory-based decisions on what is 'safe' to offer
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Methodology & Sources
Data collected via OSINT from regulatory filings, industry audits, and verified case studies.
Related Business Risks
State Board Discipline and Fines for Practicing Beyond Scope
Delayed Reimbursement Due to Payer Disputes over Scope Compliance
Clinical Capacity Lost to Navigating Ambiguous Scope Rules and Board Requirements
Strategic Missteps from Misjudging State Scope When Designing Services and Expansion
Lost Revenue from Rejected Chiropractic Claims Due to X-ray Documentation Gaps
Medicare Claim Denials from Inadequate X-ray and Subluxation Documentation
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