Did Medicare Send You a CBR?

The Illinois Chiropractic Society is hearing from some members that they have received a Medicare Comparative Billing Report (CBR), and we know that can be unsettling. We hope the following information highlights how you can use your CBR to take a proactive stance, ensure alignment with Medicare requirements, and maintain confidence in your practice. Here’s what you need to know to make the most of your CBR.

It is important to know that receiving a Comparative Billing Report (CBR) is not an indication of wrongdoing, an audit, or a medical review. It is also not a prompt to change your clinical care or a request for a response. Instead, a CBR is issued because your billing pattern differs from your peers, which may place you in an anomaly-type scale in certain areas.

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Here’s what you should NOT do:

• Don’t panic or worry. Remember, according to Medicare, a “CBR educates providers about Medicare’s coverage, coding, and billing rules and acts as a self-audit tool for providers.” It is an educational tool.
• Don’t ignore the information it provides.

Here’s what you should do:

• Review the Report: Carefully examine the CBR to understand how your billing patterns compare to other chiropractic physicians. The report is meant for educational purposes, providing you with an opportunity to assess your billing practices.
• Assess Your Practices: Consider whether your documentation and billing practices align with Medicare requirements. The CBR may highlight areas such as the average allowed services per beneficiary, the percentage of CMT spinal services billed with specific codes, and the use of the AT modifier.
• Make Necessary Adjustments: If you identify any discrepancies or areas for improvement, take steps to address them. Of course, every physician should conform to the standard of care when it comes to treatment protocols for each individual patient, and every physician has a different patient population. Merely because your billing pattern falls outside the average does not imply that you should shortcut care; rather, it suggests that you review whether you might need to enhance your documentation or adjust your billing practices to ensure compliance.
• Stay Informed: Use the CBR as a tool to educate yourself about your billing practices and make improvements where necessary. This proactive approach can help you avoid potential audits in the future.

Remember, the CBR is part of Medicare’s integrity process to educate providers and ensure program integrity without initiating a full-fledged audit. If you have further questions or need assistance, consider reaching out to a compliance specialist or the Illinois Chiropractic Society for guidance.

For more information, please see this article from Dr. Mario Fucinari.

Here is a video explanation.