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Requesting a comparative billing report -- Part B providers
Last Modified: 1/16/2024
Location: FL, PR, USVI
Business: Part B
Comparative billing report (CBR) information is available to providers by SPOT or by written 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.
Part B: Provider-specific reports (Available via SPOT only)
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 three to four 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 (Available by written request only)
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 the state/territory 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 the state/territory 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 (Available by written request only)
This CBR compares the state/territory’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 state’s/territories’ 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.
Part B providers may request a provider-specific CBR through First Coast’s Secure Provider Online Tool (SPOT) or an E&M CBR through a written request.
Option 1 -- Request a CBR online through SPOT
To learn how to submit a CBR request using SPOT, view section 9 – Retrieve documents: Comparative Billing Report (CBR) -- Part B of the
SPOT user guideNote: Requests for CBRs through SPOT generally take between 30-60-minutes to process. Note: Requestors may log off SPOT while waiting for the report to be generated.
Or
Option 2 -- Submit a written request for a CBR
To submit a written request for an E&M 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
PO Box 3411
Mechanicsburg, PA 17055-1825
Note: 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 American Medical Association. All rights reserved. Applicable FARS/DFARS apply.
Source: CMS Pub 100-08, Medicare Program Integrity Manual, Chapter 3, Section 11.1.6
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