Last Modified: 9/23/2020
Location: FL, PR, USVI
Business: Part A
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 for providers when conducting self-audits.
Medicare compares a Part A provider to its peers by type of bill using quantity billed per beneficiary per procedure code. This type of CBR contains billing information for a provider in intervals defined by the requester.
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.
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 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 CBR request must include the Medicare provider number, the dates of service preferred, and the applicable type of bill. Due to the volume of data, Medicare cannot generate a report for types of bill 11X or 12X.
• 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 3411
Mechanicsburg, PA 17055-1825
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.
Source: CMS Pub 100-08, Medicare Program Integrity Manual, Chapter 3, Section 11.1.6
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