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:
- 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
PO 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.
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 Medicare IDs | 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. Medicare IDs Per Day -- Provider |
Average number of Medicare IDs serviced by provider -- per day Calculated by: |
| Avg. Medicare IDs Per Day -- Peers | Average number of Medicare IDs serviced by provider’s Peer Group -- per day Calculated by: Total Number of Medicare IDs 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 |