Medicare to Release Another Chiropractic Comparative Billing Report, Says Dr. Tom Necela of The Strategic Chiropractor

The Centers for Medicare & Medicaid Services (CMS) plan on releasing another comparative billing report to the chiropractic profession on September 26, 2011. Chiropractors are urged to use this report to improve billing practices in order to avoid audits.

Seattle, WA, September 16, 2011 --( On September 26, 2011 the Centers for Medicare & Medicaid Services (CMS) will release a national provider Comparative Billing Report (CBR) aimed at the chiropractic profession - again.

This is the second year in a row that chiropractors across the country have received a CBR. The latest round is a similar analysis equivalent to the one distributed last fall except this current study will focus on 2010 data.

The 2011 CBR will be sent to 5,000 different chiropractors around the country from the DC’s who may have received a CBR in the last round. The intent of the second transmission, however is still the same as the CBRs contains actual data-driven tables and graphs with an explanation of findings that compare provider’s billing and payment patterns to those of their peers located in the state and across the nation.

According to the press release on Medicare’s website, “CMS has received feedback from a number of providers that this kind of data is very helpful to them and encouraged us to produce more CBRs and make them available to providers.”

Dr. Tom Necela of the Strategic Chiropractor, is the nation’s first chiropractor who achieved certification as a Professional Medical Auditor, but he is not so sure about the “positive feedback” Medicare proclaims. “As a billing, coding, documentation and compliance consultant for chiropractors, I received an incredible number of emails and phone calls from concerned chiropractors who had no clue what the CBR represented and many had no idea how to interpret the data.” As far as Dr. Necela can recall, none of the doctors appeared “happy” about receiving the CBR or pleased about its feedback.

In addition, Dr. Necela notes that he witnessed several examples where the CBR data was extremely flawed. “One chiropractor called and was flabbergasted how she could have received a CBR report when she had just opened her practice and only treated a handful of Medicare patients. Despite that fact, the CBR made her look like she had treated dozens of patients for lengthy episodes (in fact, longer than she had been in practice).” Other chiropractors were equally concerned about the accuracy of the CBR data and how it was obtained.

Based on last year’s response, perhaps the biggest question on the minds of chiropractors who will receive the CBR is what these data reports mean in the context of future audits.

“The real value and the real danger in CBR data analysis,” explains Dr. Necela, “is that the process involves the same data-mining tools used by Medicare audit contractors to identify candidates for audits. In other words, the vulnerabilities identified in the CBR tend to be the same as those identified by CMS contractors who select providers for audit.”

Based on this, Dr. Necela recommends that those who do receive a CBR, use it as a wake-up call to improve upon their billing, coding or documentation procedures which may not be up to standard or that are significantly outside the norm. Although the CBR is not punitive and although there is not a direct correlation between those receiving the CBR and those who will be audited, most experts would agree that chiropractors should use this as an opportunity to be proactive – before the auditor comes knocking.

The Strategic Chiropractor
Dr. Tom Necela
(253) 370-6156