This past week or so, 5000 chiropractors nationwide received a “present” in the mail in the form of a Chiropractic Comparative Billing Report (CBR).  Even though I had previously reported that this would happen (see my previous post “Medicare Releases Chiropractic’s Comparative Billing Report Pilot”), my email inbox now knows what it must feel like to be a postal carrier during the holiday season.

Although, the CBR is not punitive or an audit per se, the report has certainly stirred up strong feelings in our profession and got a whole lot of people suddenly worried about their billing practices and level of audit risk.

At this point, it is not humanly possible for me to respond to all the emails that I have received on the CBR from the profession at large.

However, I will offer the following blog post to address many of the common concerns and questions I have received from chiropractors wondering what to do about their CBR.

Explaining the Average Number of Services Billed Data

In this category represented by Table 1/Figure 1, the average number of services you billed per CMT code (98940, 98941 and 98942) are compared to those in your state and to national data.  As indicated in the CBR, “a statistically significant difference from your peers may be an indication of improper usage.”

There are a few things to consider in relation to this Table 1/Figure 1 data:

  • The CBR is for educational purposes and is not an audit or indication of wrongdoing.  It is a summary of statistical data and therefore, the trends shown about you and your practice may indicate that you treat your patients, on average, more than the other DC’s in your state and/or the nation.  If you are confident your documentation supports your care and meets medical necessity, so be it.  You are in the top 10% or so of chiros in terms of Medicare utilization measured in this manner, but someone has to be there.
  • If you have a very large Medicare practice base….  Let’s face it, some states have a statistically larger percentage of the elderly and some areas are predominantly retirement community havens.  While this may make it seem like your numbers would be more easily skewed, the Table 1/Figure 1 category is measuring the average number of services per beneficiary (patient).  One or two “frequent fliers” who have serious conditions that warrant more treatment won’t suddenly make you look like you overtreat everyone, according to your average numbers, simply because your sample size is so large.  If you are doing things correctly, no need to panic;  your sample size may attract attention your way, but that’s certainly no indication of improper usage. If your findings came back as “higher” than your peers, well…(see next entry)
  • If your Services were listed as “Higher”, heed the warning. On the other hand, if you are uncertain as to whether your documentation would stand up under scrutiny, the graphs and numbers  in Figure 1 and Table 1 of the CBR indicate that you are much “higher” than your peers, this report should present you with some concrete motivation to buckle down and fix your documentation.  Your billing patterns will likely draw future audit attention, so now is the time to fix them.

One Glaring Problem to Fix


  • Every patient is on Active Treatment. A high usage per beneficiary could also mean that you never deem anything maintenance; in other words, every Medicare patient is always treated as if they have an acute condition and billed with the –AT modifier.  Unfortunately, this practice probably does indicate improper usage because statistically speaking, at least some of your patients would have to come in for maintenance some of the time. So, instead of 11 treatments active and 9 maintenance over the course of a year (random numbers, of no significance whatsoever); you wind up with 20 visits all billed as active care –AT and your numbers are nearly twice as high as your 11 Active, 9 Maintenance peers.  My suggestion: study your carrier’s policy on what constitutes maintenance and if it walks like a duck, talks like a duck and looks like a duck, it’s probably best you call it a duck.


For Proactive Minded Problem-Solvers

If you don’t like the idea of Medicare or any other payer potentially taking money back from you for what they determine to be substandard or improper billing, coding or documentation, now is the time to be proactive and get a Preventative Audit. Many don’t like that term, so I prefer to call them a Documentation Review.

Certainly, the most accurate way for me to assess your entire business structure – including your billing, coding and documentation practices – is to have me come to your office and/or engage in private consulting to improve your practice.

But for those whose location provides a “geographical challenge” or whose budget is not currently in favor of scheduling me to come to your office, the Documentation Review may be a good option for you.  Here’s how it works:

You submit your notes (along with your billing and coding) and I will scrutinize them with a fine-toothed comb making sure that your services are properly documented and that you used the appropriate CPT code and bill the services performed.  Following my review of your notes, you will review a painstakingly (and perhaps, painfully) detailed written review of your shortcomings and areas needing improvement according to published guidelines and my experience as a former Insurance Claims Analyst and my training as a Certified Professional Coder, Certified Professional Medical Auditor and Certified Compliance Professional.  For more specifics on the Documentation Review process, options and fees, send an email to [email protected] and please put Documentation Review Inquiry in the subject line.


Stay tuned!  In Part 2, I will report on the remainder of the Chiropractic Comparative Billing Report.