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Last Modified: 11/24/2017 Location: FL, PR, USVI Business: Part A

CBR: Guide -- Part A

The Comparative Billing Report (CBR) for Part A providers furnishes a detailed examination of the comparative data that Medicare considers when determining how the provider’s billing patterns contrast with those of its peer group, which is based upon type of bill (TOB).
A CBR may be a helpful tool for providers when conducting self-audits and is available by request. 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.
Note: Part A CBRs for providers in Florida, Puerto Rico, and the U.S. Virgin Islands are available upon request from First Coast Service Options Inc. (First Coast).

How to request a Part A CBR

To request a CBR, providers must follow these steps:
1. 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.
2. 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.
3. 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.
4. 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 2078
Jacksonville, FL 32231-0048
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.

Part A CBR: Results overview

Medicare compares a Part A provider to its peers by type of bill. This type of CBR contains billing information for a provider in intervals defined by the requester. The variables included in the CBR will vary depending on the specified type of bill.

Part A CBR results overview: TOB 76x

Report compares only the procedure codes and APC (ambulatory payment classification) codes billed by the provider and outlier payments sent to the provider.
Results encompass only the claims information related to the provider number identified in the header (top) section of the report.
Information featured in the header section outlines the parameters of the report, including the dates specified in the request, total number of beneficiaries for whom claims were submitted, type of bill, and area.
Data is reported in descending order based upon paid dollars per procedure code.
Report furnishes a comparison of the provider’s claims activity against the provider’s peers (i.e., all other providers who have billed the same type of bill). Note: Validity of report is based upon the assumption that all providers included within the comparison have reported accurate type of bill and claims information to the contractor.
Report only includes information pertaining to the requesting provider’s Medicare patients.
Report should be reviewed moving across columns left to right.
Part A CBR -- TOB 76X report identifiers and descriptions

Report Identifier:
Description:
Procedure Code
Procedure code for the service(s) billed by the provider
Provider -- Unique HICs
Total number of beneficiaries for whom the provider rendered a service based upon the procedure code
Provider -- Billed Services
Total number of services billed for the procedure code listed by the provider
Provider -- Covered Services
Covered services billed by the provider
Ratio I -- Peer
A statistical comparison of a specific service rendered within the provider’s Peer Group
Calculated by:
Total services billed for a specific service for all providers in the provider’s Peer Group divided by the total number of beneficiaries serviced by the Peer Group
Ratio I -- PIN
A statistical comparison of a specific service rendered by the provider to all beneficiaries serviced by the provider.
Calculated by:
Total services billed for a specific service divided by the provider’s total beneficiary population
Ratio II -- Peer
A statistical comparison of the number of times the provider’s Peer Group rendered a specific service to each beneficiary who received that service
Calculated by:
Total number of services billed for a specific service divided by the number of beneficiaries who received the service
Ratio II -- PIN
A statistical comparison of the number of times the provider rendered a specific service to each beneficiary who received that service
Calculated by:
Total number of services billed for a specific service divided by the number of beneficiaries who received the service
APC
Ambulatory Payment Classification code billed by the provider
APC Descriptor
Descriptor for the APC billed by the provider
Days Billed -- Prov Actual
Number of days billed by the provider for the APC during the timeframe specified by report parameters
Days Billed -- Peer Avg.
Average number of days billed by provider’s Peer Group for the APC during the timeframe specified by report parameters.
Calculated by:
Total Days divided by Total Number of Providers in the Peer Group
Avg. Paid Per Day -- Provider
Average amount paid to provider -- per day.
Calculated by:
Total amount paid divided by Total Number of Days for the APC code listed
Avg. Paid Per Day -- Peers
Average amount paid to provider’s Peer Group -- per day.
Calculated by:
Total Amount Paid divided by Total Number of Days for the APC code listed
Avg. HICs Per Day -- Provider
Average number of HICs serviced by provider -- per day
Calculated by:
Total Number of HICs divided by Total Number of Days for the APC code listed.
Avg. HICs Per Day -- Peers
Average number of HICs serviced by provider’s Peer Group -- per day
Calculated by:
Total Number of HICs divided by Total Number of Days for the APC code listed
Prov. Total Paid -- Total Amount
Total paid to provider for the APC code listed
Prov Total Paid --
% of Total
Percentage of the entire payment received by the provider for the APC code listed
Peers Total Paid -- Total Amount
Total paid to the provider’s Peer Group for the APC code listed
Peers Total Paid --
% of Total
Percentage of the entire payment received by the provider’s Peer Group for the APC code listed
Outlier Payment Totals --
Total Providers Paid
Number of providers who received outlier payments
This volume includes the provider and the provider’s Peer Group
Outlier Payment Totals --
Grand Total Paid
Total amount paid for all providers who received outlier payments This amount includes the provider and the provider’s Peer Group
Outlier Payment Totals --
To Provider
Total amount paid to provider for outlier payments
Outlier Payment Totals --
To Peers
Total amount paid to the provider’s Peer Group for outlier payments
Total Claims -- Provider
Total number of claims billed by the provider for outlier payments
Total Claims --
Peers
Total number of claims billed by the provider’s Peer Group for outlier payments

Part A CBR results overview: TOB 21x

Report compares only the Resource Utilization Group (RUG) codes that are billed by the provider to categorize residents for Medicare payment under the skilled nursing facility prospective payment system.
Results encompass only the claims information related to the provider number identified in the header (top) section of the report.
Information featured in the header section outlines the parameters of the report, including the dates specified in the request, total number of beneficiaries for whom claims were submitted, type of bill, and area.
Data is reported in descending order based upon paid dollars per RUG code.
Report furnishes a comparison of the provider’s claims activity against the provider’s peers (i.e., all other providers who have billed the same type of bill). Note: Validity of report is based upon the assumption that all providers included within the comparison have reported accurate type of bill and claims information to the contractor.
Report only includes information pertaining to the requesting provider’s Medicare patients.
Report should be reviewed moving across columns left to right.
Part A CBR -- TOB 21X report identifiers and descriptions

Report Identifier:
Description:
RUG Code
The Resource Utilization Group (RUG) code for the services billed by the provider
# Benes. Who Received This RUG -- Provider
Total number of beneficiaries for whom the provider rendered a service based upon the RUG code.
Number of Days Billed --
Provider
Total number of days billed for the RUG code listed by the provider
Average Days Per Patient --
Provider
Average days per patient billed by the provider.
Calculated by:
Total Number of Days divided by Total Patient Count for those that were categorized with the listed RUG code
Total Allowed Amount --
Provider
Total allowed amount for the RUG code for services rendered by the provider
Percent of Total Allowed --
Provider
Percentage of the total allowed for all RUG codes billed by you.
Calculated by:
Total Allowed for the RUG code listed divided by the Total Allowed for all RUG codes billed by the provider
Average Days Per Patient --
Peer Group
Average days per patient billed by the provider’s Peer Group.
Calculated by:
Total Number of Days divided by Total Patient Count for those that were categorized with the listed RUG code billed by the provider’s Peer Group
Average Allowed Amount --
Peer Group
Average allowed amount for the RUG code for services rendered by the provider’s Peer Group
Calculated by:
Total Allowed Amount divided by Total Number of provider’s peers that billed the listed RUG code
Percent of Total Allowed --
Peer Group
Percentage of the total allowed for all RUG codes billed by the provider’s Peer Group
Calculated by:
Total Allowed for the RUG code listed divided by the Total Allowed for all RUG codes billed by provider’s Peer Group

Part A CBR results overview: TOB 13x, 14x, 23x, 74x, 75x, or 85x

Results encompass only the claims information related to the provider number identified in the header (top) section of the report.
Information featured in the header section outlines the parameters of the report, including the dates specified in the request, total number of beneficiaries for whom claims were submitted, type of bill, and area.
Data is reported in descending order based upon paid dollars per procedure code.
Report furnishes a comparison of the provider’s claims activity against the provider’s peers (i.e., all other providers who have billed the same type of bill). Note: Validity of report is based upon the assumption that all providers included within the comparison have reported accurate type of bill and claims information to the contractor.
Report only includes information pertaining to the requesting provider’s Medicare patients.
Report should be reviewed moving across columns left to right.
Part A CBR -- (13x, 14x, 23x, 74x, 75x, or 85x) report identifiers and descriptions

Report Identifier:
Description:
Procedure Code
The Current Procedural Technology® (CPT) code and short descriptor defining the services billed
# Benes Who Received This Service-- Prov
Total number of beneficiaries for whom the provider rendered a service
Percent of Detail Lines Billed -- Prov
The percentage of the number of detail lines for the procedure code listed as compared to all detail lines billed by the provider
# Units Allowed -- Prov
The total number of units allowed for the procedure code listed for the provider
Average Services Billed Per Patient -- Prov
The average number of services billed for each patient who received this service
Calculated by:
Total services for a specific service divided by the number of patients who received this service from the provider
Average Services Billed Per Patient -- Peers
The average number of services billed for each patient who received this service from the provider’s Peer Group
Calculated by:
Total services for a specific service divided by the number of patients who received this service from the provider’s Peer Group
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