For those of you who are wondering why I am devoting three blog posts to the Chiropractic Comparative Billing Report, it is this: even if you did not receive a CBR, there is a wealth of opportunity and danger in the data derived from the CBR. Put simply, Medicare has sent the CBR as warning signal (for some of you) that what you are communicating to Medicare (and other payers) may not comply with guidelines and meet the requirements you need to get paid.
While none of your results from the tables or graphs from the CBR should be viewed as a problem in and of itself, there are a few “dangerous” conclusions that you definitely do not want drawn from your practice patterns – whether or not you received a CBR.
Perhaps the most problematic parameter derived from the CBR would be if the data on Figure 1 indicated that your average number of services per visit were high compared to your peers and your top 5 diagnosis codes (Fig 3) were all short term duration codes. This type of “mismatch” essentially states that you treat patients for a long (or longer) period of time, despite the fact that the problems that you have diagnosed them with are relatively minor.
For example, cervicalgia or lumbalgia are problems that are anticipated to merit relatively short term treatment. In other words, you should be able to resolve these conditions fairly quickly. If your typical treatment pattern is that you diagnose a patient with cervicalgia and treat them, on average, for 76 visits, can you see where the disconnect may exist between what you are doing and what you are communicating?
Similarly, if you tend to take care of patients for a relatively high number of visits (Fig 1) and diagnose relatively few distinct conditions (Fig 2), this could also be a potential mismatch, particularly if the few conditions you diagnose are short term. By having relatively few conditions that you diagnose (over the course of a year, with a particular patient), it is possible that this could mean the condition was severe. It is also possible that this could mean you just don’t update diagnosis codes or re-examine your patient much.
The CBR also has the ability to show you how you compare to your peers who practice in your state. While it may be helpful to compare us on a national basis, it is also helpful to know how you compare to those in your immediate vicinity because this can affect how your local Medicare carrier may administer reimbursement decisions.
For example, if all the chiropractors in one particular state were significantly out of range compared to other DC’s nationally, it may make your carrier wonder why you practice so differently. So while I am not saying every DC has to practice the same everywhere, if you are far off range from those who practice in your state, you may want to be on the alert that this may cause some audit attention your way in the future. Similarly, state associations who had many doctors receive CBR’s indicating that they were far outside the norm may use this information as an opportunity to educate the DC’s in their state on proper billing, coding and documentation requirements.
It is my opinion that the Chiropractic Comparative Billing Report can certainly serve to be a wake up call for many DC’s out there and for the profession at large. It is in our best interest to improve our practices and patterns NOW – before we reap the consequences of what we have sown.