Last Modified: 2/27/2021
Location: FL, PR, USVI
Business: Part A, Part B
Q: I requested a Part B Comparative Billing Report (CBR) from SPOT; however, no data was displayed in the first section of the report. Why would this happen?
A: The Part B Comparative Billing Report (CBR) furnishes access to comparative data that Medicare considers when determining how a provider's billing patterns compare and contrast with others within the same specialty.
CBR data may not be available for a provider if:
• The date of service parameters of the CBR request do not encompass finalized claims
Note: Since Medicare bases a Part B Provider-specific 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.
• The provider belongs to Medicare specialty code 70 (i.e., multi-specialty clinics and group practices)
Although there are three types of Comparative Billing Reports (CBR) available to Part B providers, the only type of CBR available through SPOT is the provider-specific CBR.
The provider-specific CBR for Part B providers shows how an individual physician or non-physician practitioner compares to his or her peer group by using their specialty as the basis for forming the peer group.
• Provider-specific CBRs are most useful for individual physicians and non-physician practitioners
• Provider-specific CBRs are not considered useful for providers belonging to the Medicare specialty 70 (i.e., multi-specialty clinics and group practices).
To learn more about Medicare provider and supplier specialty codes, please click here
• Provider-specific CBRs furnish a comparison of the provider’s claims activity against peers
• Provider-specific CBRs report data in descending order based upon allowed dollars per procedure code
• Requests for Provider-specific CBRs generally take between 30-60-minutes to process, but requestors may log off SPOT while waiting for the report to be generated.
The first page of the CBR will contain a listing of the column headings and corresponding descriptions of the data contained within the first section of the report.
Part B – Provider-specific CBR: Report descriptors
The provider-specific CBR encompasses 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
• The provider-specific CBR 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.
• The provider-specific CBR only includes information pertaining to the requesting provider’s Medicare patients
Part B – Provider-specific CBR: Section one, page one
Part B – Provider-specific CBR: Section one, page two
Part B – Provider-specific CBR: Section two
To learn more about the variety of Part B CBRs
available through First Coast, please review the CBR: Guide -- Part B
To learn more about Part A CBRs
available through First Coast, please review the CBR: Guide -- Part A
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