Print
Last Modified: 5/5/2010
Location: FL, PR, USVI
Business: Part B
Requesting a comparative billing report -- Part B providers
Comparative billing report (CBR) information is available to providers by request. The purpose of the CBR is to show comparative data Medicare considers when determining how a provider’s billing patterns contrast with other providers in the same specialty. A CBR may be a helpful tool when conducting self-audits or preparing for a seminar or medical society meeting.
Types of comparative billing reports
Part B Provider-Specific
This type of CBR, best suited for individual physicians and non-physician practitioners, contains comparative information for all procedure codes billed. It is also available to specialties such as independent diagnostic testing facilities or clinical laboratories; however, due to the various types of services offered, the results will not be an “apples-to-apples” comparison. This type of CBR does not have value for physician groups.
Since Medicare bases a CBR on dates of service and not processed dates, Medicare must allow two to three months to permit claims to be finalized before a report can be generated. For example, January data is not available until April or May.
Evaluation and Management Distribution -- Provider-Specific
This type of CBR compares an evaluation and management (E&M) code family (example: CPT codes 99211-99215) to the provider’s peer group (specialty) within Florida and the nation. The report is a bar graph distribution and depicts a provider’s percentage of allowed services per procedure code as compared to Florida and the nation. This CBR is useful to identify potential variances in coding within a code family.
Medicare updates the reports two times per year for the following dates of service:
• January through June
• July through December
Since Medicare bases a CBR on dates of service and not processed dates, Medicare must allow three to four months to permit claims to be finalized before a report can be generated. For example, the January through June timeframe is not available until September or October.
Evaluation and Management Distribution -- Service-Specific
This CBR compares Florida’s utilization of E & M codes to the nation by specialty. This report is useful for medical society meetings to show variance within a code family between Florida’s provider specialties and the nation.
The CMS Data Center updates the national data two times per year for the following dates of service:
• January through June
• July through December
Medicare must allow three to four months before a report can be generated. For example, the January through June timeframe is not available until September or October.
How to request a comparative billing report
To request a CBR, providers must follow these steps:
• A provider must request a CBR on office or corporate letterhead and the provider/officer signature must be affixed. A request from a corporate entity must be submitted by a corporate officer, or in the case of a hospital, the hospital administrator. If the requesting provider wants the information sent to another party, it must be noted in the letter.
• The request must include the following information: the type of CBR(s) desired, the individual provider number(s), and the dates of service preferred. Please beware that a CBR cannot be produced using the group Medicare number.
• The mailing address must be stated clearly and legibly in the letter, since these reports will only be sent via the U.S. mail and not electronically.
• The request must be faxed to Statistical and Medical Data Analysis at 904-361-0543 or mailed to:
First Coast Service Options
Statistical and Medical Data Analysis
P.O. Box 44288
Jacksonville, FL 32231-4288
Statistical and Medical Data Analysis
P.O. Box 44288
Jacksonville, FL 32231-4288
There is no fee for providing these reports.
Once Medicare receives a CBR request, the report and a CBR explanation document will be mailed to the requesting provider (or authorized party) within 10 business days.
Italicized and/or quoted material is excerpted from the American Medical Association Current Procedural Terminology. CPT codes, descriptions and other data only are copyrighted 2004 American Medical Association (or other such date of publication of CPT). All rights reserved. Applicable FARS/DFARS apply.
Source: CMS Pub 100-08, Medicare Program Integrity Manual, Chapter 3, Section 11.1.6
