ANJC Medicare Update — January 2023

by | Jan 30, 2023 | ANJC News, Industry News, Uncategorized

Submitted by: Richard C. Healy, D.C., ANJC Medicare Consultant

What: Medicare Comparative Billing Report: Chiropractic Manipulative Treatment of the Spine

When: During the month of January, some members may receive an email to access their Comparative Billing Report (CBR)

From: Look for an email from cbrpepper.noreply@religroupinc.com 

Why: Use the data-driven report to compare your billing practices with those of your peers in your state and across the nation.

Value:

  • Reflects providers’ billing patterns as compared to their peers
  • Provides information about vulnerabilities to the Medicare Trust Fund
  • Informs providers whose billing patterns differ from those of their peers

What it is Not:

  • Indication of Wrongdoing
  • Audit or a medical review
  • A prompt to change your clinical care
  • A request for a response

Who: You will receive a CBP because:

  • Your billing patterns differ from your peers’ patterns, based on comparisons on a state, specialty, and/or nationwide level and
  • Has at least 60 beneficiaries with paid claims submitted for CMT of the spine, and
  • Has at least $20,000 in total charges for CMT of the spine.

Metrics Analyzed:

  • Average Allowed Services per Beneficiary
  • Percentage of Allowed Services of CMT of the Spine Billed with CPT® Code 98942
  • Percentage of Claims Submitted with Modifier AT

Importance of CBR:

  • Ensure claims are correctly submitted to Medicare,
  • Complete self-audits for compliance purposes, and
  • Review and confirm the importance of proper documentation and code assignment

Information: For additional information of the CBR: https://cbr.cbrpepper.org/Portals/0/Documents/CBR_202301/CBR202301-CMT-of-the-Spine-Webinar-Slides-508.pdf?ver=2023-01-23-134229-853

Register for Tutorial: Visit https://cbr.cbrpepper.org/Home

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