Heartland Chiropractic Billing Network

The Situation

Heartland Chiropractic Billing Network had been operating for seven years, managing billing for 23 chiropractic practices across four midwestern states. Annual collections were $3.1M. The business had grown steadily, but the owner had noticed that growth was not improving the bottom line at the rate it should. Margins had compressed over three years despite revenue going up.

When Mirlo Systems ran the initial audit, the answer was in the AR aging. Forty-one percent of total AR was sitting past 90 days. For a $3.1M operation, that represented over $270,000 in aging claims generating no cash flow and at increasing risk of becoming unrecoverable as timely filing windows closed and payer interest in resolving old claims declined.

The AR was aging because follow-up was inconsistent. The team had a process on paper. In practice, AR follow-up happened when staff had time after new claims were submitted, which meant the 30 and 60 day buckets were getting attention and the 90-plus bucket was largely ignored. Claims in the 90-plus bucket were effectively invisible until a payer audit or client inquiry surfaced them.

What Was Breaking

Chiropractic billing carries a specific Medicare compliance burden around medical necessity documentation. The 12% personal injury mix added a separate complexity layer: PI claims were sitting in AR not because of payer action but because the lien resolution process required coordination with attorneys, and that coordination was happening on an ad hoc basis with no systematic follow-up cadence.

The commercial payer side had a separate problem: four of the 23 practices had not been credentialed with a specific regional commercial payer that had acquired a competing plan 18 months earlier and now covered a material portion of their patient population. Those claims were being denied with CO-31 not-credentialed denials. The practices were re-billing after credentialing was eventually completed, but an estimated $44,000 in claims had exceeded the payer resubmission window before that happened.

The AR follow-up failure compounded both problems. Without daily systematic follow-up on aging accounts, the credentialing denials aged silently until the resubmission window closed. The PI claims sat in a lien queue with no follow-up cadence. Both represented recoverable revenue that was becoming unrecoverable through inaction.

The Build

The first priority was the 90-plus day AR bucket. Mirlo Systems built a daily AR follow-up system that worked every aging claim on a defined cadence based on dollar value and timely filing risk. Claims over $300 in the 60-plus day bucket received a follow-up action every seven days. Claims in the 90-plus bucket with less than 30 days of timely filing runway were escalated to a priority queue worked daily. Within 60 days, the 90-plus AR bucket dropped from 41% of total AR to 17%.

The personal injury lien queue was given a structured follow-up cadence for the first time. Each PI claim was assigned a follow-up date 30 days from last contact, with an automatic escalation trigger at 60 days of no response. The lien resolution timeline across the PI portfolio compressed from an average of 11 months to under 6 months.

A credentialing monitoring alert was built to flag any active payer in the network where one or more practices lacked confirmed credentialing status. The four practices with the CO-31 problem were flagged in week one. Credentialing was completed within 45 days. The alert system now catches any new payer relationship or plan acquisition before claims are submitted without credentialing in place.

Cash flow improved measurably within 45 days of implementation. The owner reported that for the first time in three years, month-end cash position was tracking ahead of the same period in the prior year despite no change in collections volume. The recovered AR was generating cash flow that had previously been sitting on the books as theoretical receivable.