AdjustProof

Idea

A documentation audit-defense copilot for independent chiropractic practices. AdjustProof scores every Medicare visit note against CMS's active-treatment standard the moment it is written, flags notes that read as maintenance care before they get billed, and auto-builds a per-patient audit binder a practice can hand straight to a Medicare Administrative Contractor if it gets pulled for review.

Market gap

CMS's own post-payment reviews put the chiropractic Medicare improper payment rate at 33.6 percent in the 2024 reporting cycle, with insufficient documentation causing 95.5 percent of those improper payments (see Sources, CMS). A 2015-era OIG audit found about 82 percent of paid chiropractic Medicare dollars, 358.8 million dollars, were for medically unnecessary "maintenance" care that should never have been paid (OIG). CMS has since tightened the standard: a claim now needs a documented functional goal, an outcome assessment tool score (Oswestry or Neck Disability Index), and a re-evaluation at least every 30 days, on top of the AT modifier, or the visit reads as maintenance on audit.

The tools chiropractors use today do not check any of that. General chiropractic EHRs (ChiroTouch, ClinicMind/Genesis, PayDC, Platinum System) scrub codes and modifiers and store SOAP note templates, but none of them evaluate whether the narrative content of a note actually meets CMS's medical-necessity language. The response from the industry today is training, not software: KMC University and the ChiroCode Institute sell webinars and certification courses telling chiropractors what a compliant note looks like, then leave the chiropractor to apply it visit by visit, alone, under time pressure. That gap between "here is the standard" and "here is proof this note meets it" is where AdjustProof sits.

Timing: CMS named a "Documentation Compliance Audit Initiative" specifically for chiropractic claims and narrowed its definition of maintenance therapy, so post-payment reviews are getting more frequent and more literal about the exact documentation elements, right as chiropractic Medicare utilization keeps growing with an aging population.

Total Addressable Market (TAM)

Bottom-up:

• 65,850 chiropractic business establishments in the US (IBISWorld, 2025).
• Roughly 60 percent bill Medicare regularly enough to carry real audit exposure (a chiropractor's average Medicare share of gross revenue is around 8 percent per ACA-cited utilization data, but the large majority of practices see at least some Medicare patients). That gives about 39,500 practices with Medicare billing exposure.
• Assume 65 percent of those are big enough or risk-aware enough to pay for a dedicated compliance tool rather than rely on training alone: about 25,700 practices. That is the TAM.
• Blended ACV of 2,400 dollars a year (mostly Starter tier at 149 dollars a month for solo practices, some Growth tier at 299 dollars a month for multi-provider clinics).
• TAM: 25,700 x 2,400 = about 61.7 million dollars a year.

SAM: practices with meaningful Medicare audit exposure, taken as the 39.5 percent of TAM practices that bill more than roughly 300 Medicare visits a year (a threshold at which a single unfavorable post-payment sample extrapolation becomes financially serious). That is about 10,150 practices x 2,400 dollars = 24.4 million dollars a year.

SOM: realistic 24-month penetration for a 3-person team selling through chiropractic trade associations, state boards, and the billing-company channel: 2 percent of SAM, about 200 practices x 2,400 dollars = 480,000 dollars ARR. That is the year-two target, not the ceiling.

Assumptions and sources: business count from IBISWorld; improper payment rate and documentation-failure share from CMS; maintenance-care overpayment share from OIG; Medicare revenue share and practice count context from chiropractic industry data cited by the trade and association sources below.

Monetization strategy

Straight SaaS subscription billed to the practice, priced per provider seat. The practice owner or office manager pays; the value is fewer clawbacks and less time spent in self-audits, which they can measure directly against KMC-style consulting fees and against a single denied claim (Medicare's chiropractic limiting fee runs 35 to 45 dollars a visit, so extrapolated clawbacks on a sampled audit routinely run into five figures). They keep paying because every new Medicare patient generates new note-level exposure, and the audit binder becomes the practice's system of record the day a MAC actually asks for records.

Pricing strategy

• Starter, 149 dollars a month: 1 provider, up to 500 scored Medicare visits a year, PDF audit binder export.
• Growth, 299 dollars a month (anchor tier): 2 to 4 providers, unlimited scored visits, practice-wide audit-risk dashboard.
• Multi-location, 599 dollars a month plus 79 dollars per additional location: 5+ providers, multi-location roll-up reporting, priority support.

Entry point is Starter, since most target practices are solo or two-doctor offices. Growth is the anchor because most audit exposure and most willingness to pay concentrates in multi-provider clinics with real Medicare volume.

Lead magnet

A free, no-signup "AT Modifier and Maintenance Care Self-Audit Checklist" plus an instant scorer: a chiropractor pastes up to 5 real SOAP notes and gets back an audit-risk score and the specific missing elements for each, right on the page. It proves the product's core value (a note gets flagged before an auditor ever sees it) in under two minutes, with zero commitment.

Competitors

• ChiroTouch: the largest chiropractic-specific EHR and billing platform. Ships SOAP note templates, a "Compliance Scan" for coding and modifier errors, clearinghouse integration, and PQRS/quality reporting.
• ClinicMind / Genesis Chiropractic Software (XDocs): HIPAA-compliant EHR positioned on saving documentation time, with billing and scheduling.
• PayDC and Platinum System: chiropractic practice management and billing suites with claim-scrubbing for codes and modifiers.
• KMC University: compliance training and consulting for chiropractic Medicare billing, sold as webinars, manuals, and coaching, not software.
• ChiroCode Institute: publishes chiropractic coding and compliance guidance and certification courses.

What competitors offer now

The EHR players (ChiroTouch, ClinicMind, PayDC, Platinum System) check that a claim has the right code and the right modifier attached before it goes out the door. That catches missing AT modifiers, but it does not read the note itself, so it cannot tell a chiropractor that this week's SOAP note has no documented functional goal, no re-evaluation on file in the last 30 days, or no outcome assessment score, which is exactly the language CMS audits against. The training players (KMC University, ChiroCode) teach the standard well but hand the chiropractor a PDF and a certificate, then leave every single visit note to individual discipline under time pressure. Nobody in the space turns the CMS documentation standard into a per-note, real-time pass or fail with an auto-assembled defense file.

What can be done differently to attract customers

Sell the fear people already have, not a new one: chiropractors already know Medicare audits exist and already buy compliance training. AdjustProof sits next to the EHR they already use rather than trying to replace it, so the switching cost is nearly zero: paste or copy the note text in, get a score back in seconds. Go to market through the channels that already carry this message (state chiropractic associations, KMC University's own audience, chiropractic billing companies who get blamed when a clawback happens) with the free instant scorer as the wedge, then convert the practices whose notes come back red.