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How to Start A Chiropractic Cash Practice (2022)

Woman chiropractor with patient

Are you thinking of starting a cash-based chiropractic practice? Do you have an insurance-based approach and want to transition into a cash-based practice?

If so, you’re in luck! Many doctors are choosing cash practices for their patient-centered chiropractic care. In this blog post, we will walk you through the process step-by-step. We’ll provide you with all the information you need to get your cash practice off the ground and running.  

So what are you waiting for? Let’s get started!

% cash chiropractic businesses in 2020

Pros and cons of a chiropractic cash practice

There are a few things to consider before switching to a cash practice.

Pros of a cash practice

  1. You control your destiny. You’re not beholden to insurance companies’ reimbursement rates, pre-authorization limits, repayment policies, insurance coverage, or service limitations. You can set your fees and decide which services to offer.
  2. It’s easier to get paid.  With insurance-based practices, you have to wait for reimbursement from the insurance company, which can take weeks or even months. With a cash-based practice, patients pay you at the time of service, so there’s no waiting for payment. Your cash flow is more consistent.
  3. You can offer service discounts. Many insurance plans in health care have limits on how much they will reimburse for chiropractic services and restrictions regarding service discounts.
  4. You have more control over your schedule. You can be more flexible with your appointment times and programs with a cash-based practice.
  5. You can spend more time with them. Insurance-based practices often have limitations on time-based services or per diem rates that can limit your ability to provide the quality of services you want.
  6. There is less paperwork. You don’t have to deal with insurance forms and claims with a chiropractic cash practice. There is less paperwork for you and your staff and more time for patients.

Cons of a cash practice

  1. You may have to spend more on marketing. Insurance-based practices often get referrals from other providers, such as primary care physicians or orthopedists. When you switch to a cash-based practice, you may need to do more marketing to attract new patients.
  2. You may lose some insured patients as a cash-based provider. If your fees are too high or you don’t accept the insurance plans that your patients have, you may lose some patients who switch to insurance practice.
  3. There may be a limited number of patients that can pay out of pocket for your services. While many insurance co-payments are increasing, many are still lower than a cash-based office visit.  However, without insurance limitations, you will be free to provide cost-effective services such as group rehabilitation, classes on nutrition, or health coaching that can serve a broader population. You may actually be able to help more patients with a cash-based practice.


There are many pros and cons to consider before starting a cash-based practice. Regardless, a successful, patient-centered practice starts with solid business fundamentals.

Most common type of business entity is LLC

Business basics still apply to a cash practice chiropractic clinic.

You might be thinking, “I’m a chiropractor, not a business person! I just want to help people feel better.” But the fact is, if you’re going to start your cash practice, you need to have at least a basic understanding of business. After all, this is a business you’re creating!  You’ll need to know how to market your practice, manage your finances, and handle the day-to-day operations.

Of course, you don’t need to be an expert in all things business. But it’s essential to have a solid foundation before you get started.

Profesional Accounting Service for chiropractic cash practice

Setting up a business entity.

When you start a cash-based chiropractic practice, you’ll need to set up a business entity. But, first, the legal structure of your business will determine things like how you file your taxes and how much liability protection you have.

There are several different types of business entities, but the most common for small businesses are

  • Sole proprietorships
  • Limited liability companies (LLCs)
  • S corporations.

If this is a new entity, we recommend talking to an accountant or attorney who can help you figure it out. Setting up your entity is easy sith sites such as LegalZoom and Zenbusiness. Accounting services such as Xendoo specialize in small business accounting.

Set up basic accounting and bookkeeping practices

If you’re not already doing so, now is the time to set up some basic accounting and bookkeeping practices. Accurate bookkeeping will help you keep track of your finances and ensure that your business runs smoothly.

There are several different software programs you can use to manage your finances.  Quickbooks is easy to use and affordable.

Once you have your accounting system set up, record your income and expenses. This habit will help you stay organized and know where your money is going.

Chiropractic office location considerations

Choose a location

There are a few things to keep in mind when choosing a location for your business.

  • The location is easily accessible for your patients. It should be easily accessible by car and public transportation.
  • There needs to be enough space for you to see patients comfortably. You should have enough room for a waiting area, reception area, and treatment rooms.
  • Extra space for additional services such as massage, rehabilitation exercise training, or nutrition consultation will allow you to expand your revenue streams.
  • Make sure the location is in a good spot for marketing. It should be in a visible location with good foot traffic. Take note of traffic patterns and proximity to major thoroughfares. Adequate parking and access to public transportation are essential considerations.

Marketing your chiropractic cash practice

Now that you have everything set up, it’s time to start marketing your practice. This can be more challenging without accepting insurance. However, it is also an opportunity to communicate to patients the benefits of providing a variety of services within your scope of practice without the limitations of insurance.

Group chiropractic practices higher reimbursements

The first step is to identify your ideal patient.

  • Who are you serving?
  • What are their needs, and how can you meet them?
  • What are the demographics? (Age, gender, income, location, etc.)
  • What services do you want to provide?
  • What products do you want to sell?

Once you have a good understanding of your ideal patient, you can develop a marketing plan.

A successful cash practice starts with clear communication with patients.

Insurance co-payments and premiums are an increasing cost to patients, and the time and expense of billing and collecting on insurance claims is a rising cost to chiropractors.

It is reasonable for chiropractors to reduce their overhead costs and expand their services and time spent with patients by eliminating insurance billing.

Cash-based practices allow chiropractors to spend more time and provide more services for a competitive fee with less overhead and less hassle with billing insurance. As a result, patients will see results faster without a chiropractor’s limitations on services and may save money in the long run.

Average additional annual compensation chiros with specialists

Health insurance coverage and cashed-based practice

A cash-based practice has patients who still want to use their insurance benefits. As a cash-based practice, you will be out-of-network for private insurance companies and a non-participating provider for Medicare.  Medicare has unique requirements for chiropractors, and you still have responsibilities to meet. The best course is to call CMS directly and ensure you meet all your obligations.

Pricing and payment options for a cash practice

One of the most critical aspects of your cash-based practice is pricing. You’ll need to determine how much to charge for your services to make a profit.

There are a few things to consider when setting prices for your services.

  1. Consider your overhead costs, including rent or mortgage for your office space, utilities, insurance, marketing, and other general business expenses. These are regularly occurring payments.
  2. What is your ideal profit margin?  This is the money you want to make after all expenses. A good rule of thumb is to follow the 30:30:40 rule — estimate 30% of gross revenue to taxes, 30% for overhead, and 40% profits.
  3. Have a clear script to communicate to patients how they can use their out-of-network insurance benefits.  Install a process for patients to submit a bill to their insurance company for direct reimbursement. Make this as easy as possible.
  4. Decide on the services and products you want to provide. If you have massage therapy, acupuncture, nutrition services, and other services, consider an annual or monthly membership.

Being creative with your services allows you to be creative with pricing while offering a wider variety of services.

Most common specialist in chiropractic practice is massage therapy

Determine a reasonable payment policy

Once you have determined your pricing structure, you’ll need to develop a payment policy. There are a few different options for accepting payments in a cash-based practice.

  • Accept cash only
  • Accept checks and credit cards. Using an online portal for payments where patients can pay by check or credit card is a convenient option for patients and can help you keep track of payments.
  • You can also set up a payment plan for patients who cannot pay the total amount upfront.

Once you have developed your pricing structure and payment policy, communicate these to your patients. Sharing the payment policy in multiple locations will help avoid confusion regarding payment and help to ensure that patients can make informed decisions about their care.

Include the payment policy on your website, in marketing materials, and have a signed.

Successful marketing chiropractic reflects unique services and values

Provide a variety of services for patients

Your state’s scope of practice and your professional interests determine your practice niche.  Chiropractors are uniquely positioned to provide a variety of conservative and effective medical services. Many services are increasing in popularity and can create multiple revenue streams.

Common services provided in cash-based practices include:

  • Chiropractic adjustments
  • Manual therapies
  • Rehabilitation exercises
  • Nutrition counseling
  • Massage therapy
  • Acupuncture
  • Supplements
  • Meditation and mindfulness
  • Lifestyle coaching
  • Ergonomic assessments
  • Weight management programs

Other services that may be offered depending on the state laws and regulations include:

  • Laser therapy
  • Shockwave therapy
  • IV nutrition therapy

When starting a cash-based practice, it is essential to consider the services you are passionate about and have the training and experience to provide. In addition, patients will appreciate a well-rounded approach.


With a well-run cash-based chiropractic business, you can provide quality care while maximizing profits. However, there are some key fundamentals that you must keep in mind to make sure your practice is successful.

By following these tips and learning more about running a cash-based chiropractic business, you can create a thriving practice that patients love and that benefits you financially.

Are you thinking of starting a cash-based chiropractic practice?  Let us know how it’s going!

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This blog is for informational purposes only and does not constitute medical advice. The information contained herein should not be used to diagnose or treat any health condition or disease without consulting with a qualified healthcare provider.