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Greetings, friends, colleagues, and of course my network members. Let’s get ready. Of course, 2026 is coming. How do we prepare? Santa Claus may be coming soon, but we gotta get ready for 2026. What’s upcoming? What’s making some changes? And I think the way I always wanna start with what’s happening with fees and other things, what’s updating for the New Year’s.
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Let’s go to the slides. Let’s talk about what’s coming up. In 2026, what can we expect? What’s gonna be the change? One thing to be careful, you’re gonna see a lot of people creating ads and other things getting you, Hey, you better be ready. There’s lots of change. There’s always updates and changes, but let’s be careful.
Let’s make sure we understand what’s important to us in our profession in chiropractic. I wanna start with for 2026, and every year, let’s talk about finances. What are your charges? Have you really looked into, what am I charging? Is it fair? Is it reasonable? But also let’s focus in on what every patient wants to know.
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They wanna know how much things cost, and I want you to start thinking of, have you really set aside a financial plan and understanding for your practice? What is your cost? What is the patient’s cost? What will be the difference if you use cash or insurance? Is there, what about if you do prepaid plans, or how about these discount medical programs like ChiroHealth, USA, or similar?
Are you using those with each of those? We need a good financial understanding for ourselves. But also the patient. We need to make sure there’s no surprises. Make sure that a patient knows what’s the cost going to be. Don’t get caught. We’ve had a lot of practices, more medical than chiropractic, if you will, but have dealt with issues because they did not disclose the charges and what the costs were.
The patients can dispute it, so make sure, in simplest terms, you must disclose the cost of your service and provide a good faith estimate of what you’re gonna do, what’s the cost gonna be? You certainly can give an estimate of what insurance pays, but remember, you always highlight, you’re making no guarantee the insurance is gonna cover.
You’re simply saying it may pay some, and then they will owe the balance. And then make sure that this information provided in writing to the patient as well as orally, make sure any agreement you give cannot exceed 12 months. So nothing much longer than that. Obviously do one each time to make sure there’s no misunderstanding and do understand.
We have to make sure we’re doing a good job with this because we don’t wanna reach a point of collections and credit report. And remember, there’s gonna be states that don’t allow you to credit report anyway as well as many times the agencies just don’t accept it. So we don’t wanna reach that. We wanna know beforehand, and my suggestion is collecting copays and co-insurance at the time of the visit.
Why are we waiting? Many of you have billed all these insurances before you know approximately what they’re gonna pay, collect that amount. If you collect a little bit more, no big deal. It’s easier to refund or credit than it is to chase after it. So if you think an insurance is gonna pay 80%, collect at least 20, if not 30%.
And therefore when it does pay, if it turns out it’s more, oh, great. Re refund the patient or credit, keep in mind what I’d like you all to do is start keeping a log of what insurances are paying start at first of the year so you’ll know. Because realize we don’t bill that many insurances. Everyone thinks you’re billing hundreds.
You’re not. You’re billing a handful, start to create a nice spreadsheet of information. This is something I implore all of my network members do, and I help you with it to create a spreadsheet so you know when I bill Aetna with this plan, what is it gonna pay for this code? What is the patient’s copay?
Because we wanna make sure there’s no surprises. Patients understand, and we don’t wanna reach a point of collections. And this brings me to, because it’s gonna be the new year, have you really thought of your charges? What are you charging for each of these codes? What was it this year, if you will? 2025?
What is it gonna be for next year? Now, relative values aren’t out yet, but I will highlight they’re gonna be in the same range. Here’s my point. You wanna start to determine what’s fair based on a code compared to another. Every code has a relative value, meaning if a code is worth one. Another code is worth 1.5.
That code would be 50% higher. So one of the ways to do this is start to look at the codes that you bill. So by example, let’s just say you’re charging $60 for your 9, 8, 9 4, oh. It has a relative value, at least for this year of 0.82. So that means you take your price divide by the relative value. This 73 17 becomes your conversion.
You then can go to any code. With that code, take 73 17, multiply it by its RVU to tell you the fair price. So if you’re charging 60 for 9, 8, 9, 4 oh, what would be the fair price for a 9 8, 9 4, 1? You look at this and you go, oh, okay, if I take 73 17 times 1.19, it gives me 87.07. So notice that’s a $27 difference.
Too many of you have a five or $10 difference, and that makes no sense because the value of a 99 4 1 is literally 37% higher, roughly. I’m estimating that a little bit, but you can see here generally a third. So be careful of undervaluing, because keep in mind, if they’re paying you 60 for a four, oh.
You charge 65 4 4 1, they’ll certainly pay it, but they would’ve paid you 87. So be careful of undervaluing. Now keep in mind, does this work with your A SH in some of these managed care? No, they don’t care about rvu, but I’m talking about things that don’t apply there. Obviously Medicare doesn’t use that nor does work comp, nor does personal injury and nor does general indemnity insurance.
So be careful of undervaluing. Now, if you said to me Sam, I charge less. For reasons, because you do mostly cash so long as you have a reason, but my concern is you’re charging less. Who do you think you’re helping? I’m not sure the patient’s picking you because you’re cheap. They’re picking you because you’re good at what you’re doing.
You charge a fair price. The same applies when you think of it. Notice here that pricing difference, but what about an exam? Notice the value of an exam is 3.37. You can see that’s four times the rate. Of the adjustment code of a 9 8, 9 4, oh. That’s why it’s 2 46. That’s one area you’re definitely undervalue.
And what about exercise? Exercise has a value of 0.89, so that’s 7% more. That’s why this price is 65 compared to 60. Here’s what I want you to be careful of. Too many offices don’t understand these values. If you’re a network member with me, this is imperative that we have done this and do it again at first of the year because chances are you’re gonna undervalue.
Be careful. Obviously you’re gonna be in managed care and managed care may dictate, but keep in mind, so is Medicare. Do you allow Medicare to determine the rates you bill outside of Medicare? Of course not. So start to make sure you have a good value of services and this will update. Now, the newest values will be out first the year.
I’ll certainly be turning that to you, but keep in mind, network members come with me directly, or if you attend our seminar, all this information will be there because it’s important to understand values. For states like Michigan, Florida, Indiana, they use 200% of Medicare. So simple as just take 200% of Medicare.
For most of you, 200% of Medicare generally 9, 8, 9, froze in the 30 to $33 range. You can see here, oh, that would be 60. And then the four, oh, or excuse me, four. One is in the mid 40 range, Hench, closer to 90. Even California Work comp uses 150% of Medicare. So start using these fees to help you establish what’s going on, and frankly, other states.
And here’s some examples. Arizona, Idaho, Maryland, Texas, and Utah, they just use a conversion. If you wanna know the fee for Arizona, take $69, multiply by 73, 17. That will tell you what they allow. So if I’m in Arizona, do I want that to be my price as a minimum? Yeah. No one’s ever gonna say to you, oh, you’re using the work comp rates, those are too high.
No, those are the state mandated. So start to understand that how do I set and look at these? And it’s important because at first the year I. There’s changes. The Medicare conversion is gonna be adjusted upwards. There has been adjusted upwards 3.26% for 2026. That should mean for most of us we should get a raise.
Now some of you’re gonna be hearing, coming out now saying, be careful. Medicare is reducing 95 or reducing 5%. That’s for in hospital type services, not for. Office visits. So we should see an increase, but again, we still have to wait until they’re published again, get with me at first of the year all my members to make sure we have that information.
But you should see an increase of about 3%, which means what should we do in 2026? If you are not raising your rates a little bit every year, what’s happening to your practice? It’s beginning to fail because your cost increase if you’re not keeping up with just cost of living. Even if you have the same number of patients, you’re worse off.
So that doesn’t mean you’re getting more, you’re just getting and adjusting to the economy. These changes are predicted to increase for physician payments overall, do a combination of statutory updates and conversion factor. But I like this. I’m interested to see when they’re published, how we’re gonna see how much they should change.
Let’s not get excited. What’s 3% of $30? That’s 90 cents, but that’s better than not. But what if that were 60 or 80? Again, it begins to move up. Bottom line though is understand what is changing now. Medicare will increase deductible, $26 up to 2 83. Now, does that matter very much to chiropractic?
Probably not. ’cause many people go to medical providers and get that eaten up. But keep in mind, if they’re coming to your office at the first of the year. If you have a $300 bill for the first visit, realize only this manipulation of the spine is gonna count towards. The deductible. The only thing that counts towards deductible with Medicare for chiropractic is going to be spinal manipulation.
Any other service if you’re doing an exam or therapies do not count. Now let’s focus in on what is gonna happen with relative value, whether they’re not published yet, but the indication is there’s gonna be some slight increases based upon work values as well as malpractice values. So we should see an increase there.
So pay attention, which means. Oh, I can’t just sit on my heels first of the year. Get with me network members. Let’s make sure you’re updating, because that alone is gonna change how you will value a service. Remember, two years ago we had a significant increase in e and m codes, roughly 10% acupuncturist had a large increase as well.
So make sure we’re on up to date with that. Keep in mind though, when codes update, do they update everything? Like for by example, some of you’re gonna see this 2026, there’s 288 new codes, 84 deletions, 46, changes. Those involve mostly things that do not work with us or don’t involve us at all. In fact, it’s gonna be hearing aids at the biggest or artificial intelligence.
Now, artificial intelligence, understanding, you know what that’s for X-rays. Nothing to do with treatment for chiropractic and physical medicine. There are no new code changes or definitions to those services, but do you understand them? By example, our January seminars, we’re gonna focus in on how do you deal with, can I bill for red light?
What about laser? What about vibration? What about shockwave? What of all these new technologies, how do we or can we bill for those? We’re gonna focus in on that where we will see, actually a nice change. 9 7 1 4 0 manual therapy will have an adjustment where they’ll ne they won’t apply what’s called the efficiency adjustment.
So we actually should see a significant increase in the value of that code because it used to have a 2.5% decrease and now that’s been taken away. So we should see a nice change. So what I need you to do is stay tuned. Let’s be ready. We’re gonna have seminars January 17th and 24th. Network members.
Remember, that’s for you. If you’re not a network member, get with us. Seminars are free, but make sure you have a place to go. Allow me to be your expert to help you with fees and changes. For first of the year, rvu, Medicare Work Comp, all are changing. Let’s get ready. The new year is here. I want your practice to be very successful.
See you at the new year, everyone.
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