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Last Modified: 3/22/2018 Location: FL, PR, USVI Business: Part B

CBR: Guide -- Part B

The Comparative Billing Report (CBR) for Part B providers furnishes a detailed examination of the comparative data that Medicare considers when determining how the provider’s billing patterns contrast with those of other providers of the same specialty. Use this guide to learn not only how to request a Part B CBR but also how to interpret its results to help improve your organization’s billing efficiency.
Note: Part B CBRs (provider-specific) for providers in Florida must be requested through the SPOT. E/M Distribution Provider Specific and E/M Distribution Service Specific CBRs are available upon request from First Coast Service Options Inc. (First Coast).

Part B CBR: Results overview (provider-specific)

• 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, and the county in which the provider furnishes services.
• Data is reported in descending order based upon allowed dollars per procedure code.
• Report furnishes a comparison of the provider’s claims activity against his or her peers in the same specialty. Note: Validity of report is based upon the assumption that all providers included within the comparison have reported accurate specialty and claims information to the contractor.
• Report only includes information pertaining to the requesting provider’s Medicare patients.
Part B CBR report identifiers and descriptions

Report Identifier:
Description:
(A)
Total Unique Medicare ID Count
Total number of beneficiaries for whom the provider rendered a service -- regardless of the procedure code(s) billed
Procedure Code
The Current Procedural Technology® (CPT) code and short descriptor defining the services billed
(B)
Unique Medicare IDs
The total number of beneficiaries for whom the provider furnished the individual service -- organized by CPT®/procedure code
(C)
Svcs.
The total number of services per procedure code that was billed by the provider -- regardless of the number of beneficiaries served by the provider’s practice
(D)
Allw. Svcs.
The total number of allowed services per procedure code, -- regardless of the number of beneficiaries served by the provider’s practice
(E)
Peer
(Percentage of Services)
The percentage of the specific service to all services rendered. Calculated by:
Total services billed by provider’s Peer Group or Specialty for a specific service divided by the total services billed for all services rendered y provider’s Peer Group or Specialty multiplied by 100
(F)
PIN
(Percentage of Services)
The percentage of the specific service rendered by the provider to all services rendered by the provider
Calculated by:
Total services for a specific service -- Column (C) -- divided by the total of Column (C) multiplied by 100
(G)
Peer
(Ratio I)
A statistical comparison of a specific service rendered within a provider’s Peer Group or Specialty for all beneficiaries serviced by that Peer Group or Specialty
Calculated by:
Total services billed for a specific service for all providers in the Peer Group or Specialty divided by the total number of beneficiaries serviced by the Peer Group or Specialty
(H)
PIN
(Ratio I)
A statistical comparison of a specific service rendered by the provider to all beneficiaries serviced by that provider
Calculated by:
Total services billed for a specific service -- Column (C) -- divided by the provider’s total beneficiary population -- Column (A)
(I)
Peer
(Ratio II)
A statistical comparison of the number of times the provider’s Peer Group or Specialty 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
(J)
PIN
(Ratio II)
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 -- Column (C) -- divided by the number of beneficiaries who received the service -- Column (B)
(K)
Allowed Dollars
The total allowed dollars for the claims submitted by the provider for each individual procedure code detailed within the table
(L)
Peer
(Percentage Allowed)
A comparison (by percentage) of the total allowed dollars for a specific service for all providers within the provider’s Peer Group or Specialty to all allowed dollars for all services in the provider’s Peer Group or Specialty
Calculated by:
The total allowed dollars for a specific service divided by the total allowed dollars for all services
(M)
PIN
(Percentage Allowed)
A comparison (by percentage) of the total allowed dollars for a specific service the provider rendered to all allowed dollars for all services the provider rendered
Calculated by:
The total allowed dollars for a specific service -- Column (K) -- divided by the total allowed dollars for all services -- total of Column (K)
First Coast Service Options (First Coast) strives to ensure that the information available on our provider website is accurate, detailed, and current. Therefore, this is a dynamic site and its content changes daily. It is best to access the site to ensure you have the most current information rather than printing articles or forms that may become obsolete without notice.