April 2013

April 2013

By now you've received your Comparative Billing Report (CBR). We suggest you become mindful of the following issues to make good use of the data:

1. Use the data in Table 2 to make sure all diagnosis codes are pertinent to the care you delivered and what you billed. Move irrelevant diagnoses (but are part of the patient's condition), off the claim form and into your visit notes. For example, you wouldn't be treating tuberculosis, even though it could be an underlying condition.

2. Compare your average number of visits per patient with your local and national peers. Are you under treating? Are you leaving money on the table? Will your documentation stand up to scrutiny? Acquire a better understanding of your documentation requirements and Medicare's definition of medical necessity. As they say, ignorance is expensive!

3. Was the level of 98941 higher than the other two spinal CMT codes in your report? Many who consider themselves "Full Spine Adjusters," lack sufficient documentation or necessity for it. For example, if you adjust three spinal regions does your documentation reveal two diagnosis codes for each spinal region? What about a separate treatment plan for each? Can we find a dedicated SOAP/PART note for each one that meets the definition of medical necessity?

Use the most recent CBR to evaluate your documentation practices and what's necessary according to Medicare. The Zoned Program Integrity Contractor assumes that you're deliberately committing fraud when improper billing processes are found, subjecting you to fines, penalties and possible legal action. Peace of mind begins by exploring your CBR.

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