Did You Receive a CBR from Medicare?

Medicare has sent out Comparative Billing Reports (CBRs) to chiropractic physicians. Watch the video to learn more about CBRs and how they apply to your practice!

Referenced Link

CBR 202201 Chiropractic Manipulative Treatment (CMT) of the Spine

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Transcript:

We hope you’re having a great day and you’re staying safe and the snow and the weather that at least Central Illinois is getting throughout these few days. But I wanted to kind of bring you up to speed and maybe settle some fears, if you will, or calm some fears. Earlier this year, Medicare announced that they’re going to be sending out comparative billing reports to chiropractic physicians, to certain chiropractic physicians beginning at the end of January, or early February, and you’ll get that it’ll indicate that it’s a CBR. That’s compared to billing report. First of all, I just want to make sure everybody just takes a deep breath. If you happen to receive one of these, let me tell you what it is not. A comparative billing report or a CDR is not an indication of wrongdoing, it’s not an audit, it’s not a medical review. It’s not a prompt to change your care, your clinical care that you’re providing. It’s also not any kind of request for a response. So you don’t have to respond to the CBR.

Instead, what it is, they issue these because your billing pattern is different from your peers, from other chiropractic physicians. So basically, you fall in kind of an anomaly-type scale in one of three primary areas, and we’ll cover those in just a minute. But the biggest thing is take a deep breath. This isn’t an audit, it’s nothing to fear. Instead, it gives you an opportunity to be able to take a look at your billing patterns, take a look at what they’re providing, and say, Do I need to make some adjustments? Is my documentation up to snuff? Is it you know, what do I need to do? If anything, it may just be, that your Medicare population dictates the care that you’re providing for your particular practice. And so some of this may be superfluous, right? It may not be a big deal at all. So what are they addressing inside of the CBRs?

The particular one that we’re talking about in 2022 really is centered around three different things. It’s the average allowed services per beneficiary throughout the outlook period so through a year, if you will. A percentage of CMT spinal services billed with 98942. So again, that’s the five region adjustment code, and if that one is skewed, that’s probably the biggest red flag, and all of these things, all of them are important, don’t get me wrong, but that’s the easiest one to address because you need to make sure that you are meeting the documentation requirements for all five regions if you’re billing in 98942, and that your diagnosis codes are reflecting, you know, all five regions and care to all five regions. So that’s gonna be the easiest one to take a look at right?

Then the last one is the percentage of claims billed with the modifier AT. Now, apparently, the way that they did that particular study, was that they compared those claims submitted without an AT, or in total, probably is a better way to put it, versus those with an AT modifier. So if you’re doing maintenance care, and you’re going to get to Medicare, of course, they’re going to deny it if you don’t include the AT modifier, which you shouldn’t be on maintenance care. But they’re comparing your AT billings against your total population of CMT billings to Medicare. So that’s that particular percentage that they’re looking at. So, if you have a heavy Medicare practice, and many of your patients may choose through their ABN form to not have you bill Medicare, and those particular it could actually skew your numbers a little bit in those particular regards. So just be aware of that when you go to look at the report.

Now, what does all this mean? Again, I want to double back. It’s for information and educational purposes. That’s the idea. This is a part of the integrity process that Medicare instills to ensure that the program continues to have integrity. And this is one of the ways that they can educate the doctors without going through the full-fledged audit. So it is not an indication you’ve done anything wrong, it is not an audit, and you don’t have to respond. We do encourage you to go ahead, look at your CBR look at that report, and determine is this something that I have a challenge with that I have a bit of a problem that I need to address in my practice, and then deal with that accordingly. In other words, it’s an opportunity for you to educate yourself and improve if there are some areas to improve. Sometimes there aren’t and but that’s that’s why they do it gives you the opportunity to take that action. Now, we also want to make it easy for you to be able to get the information that you need and take a look at exactly what all of this means. So, we’ve given you a quick link that gets you over to the CBR site. Just go to ilchiro.org/2022cbr. That’s 2022 CBR. So ilchiro.org/2022cbr and in that particular case, it’ll take you right over to the CBR site. It has a webinar. It has information, it has all the slides, and the transcripts of that webinar, plus it also gives you a link to be able to go look at your CBR and to answers a few other questions in there. But it’s all on one page shoot you over there. Hopefully that helps you out. Again, no need to panic. Many of you probably are going to get it. It’s okay. Just review. Take a look at it is something you need to address take action, fix if there’s a fix that needs to happen, make sure you improve your documentation if that’s important, and hopefully this helps you out and we will catch you next week. Take care.