_c7154e31-99d4-400a-9cb4-8f897a59ac22.jpg)
What is Comparative Billing Report (CBR)?
Perhaps you've already received your CBR from Medicare. It is an educational tool that reflects your billing and/or prescribing patterns as compared to those of your peers for the same services in your state, specialty, and/or nationwide. To know more about CBRs and why you got one, read along!
The Centers for Medicare
& Medicaid Services (CMS) strives to protect the Medicare Trust Fund and
effectively manage Medicare resources. To achieve these goals, CMS has
contracted with the RELI Group to develop the Comparative Billing Report (CBR)
and support health care providers with its use.
What is a CBR?
A CBR is an information tool that shows your billing and/or prescribing patterns in comparison to your peers’ billing patterns for the same services in your specialty/state and/or across the nation. The CBR is intended to enhance accurate billing and/or prescribing practices and support providers’ internal compliance activities.
Why did I get a CBR?
CMS provides you with this report because your Medicare billing and/or prescribing patterns differ from your peers’ patterns within your state/specialty and/or nationwide. Receiving this CBR is not an indication or precursor to an audit, and it requires no response on your part. However, selected providers may be referred for additional review and education.
While you carefully review the report, you may wish to check your records against the data in CMS’ files and review Medicare guidelines to ensure compliance. You can contact your Medicare Administrative Contractor (MAC) with specific billing or coding questions. As appropriate, you may share the CBR with others who may benefit from and/or assist with interpreting the data provided in the report.
In late February 2021, CMS issued a Comparative Billing Report on Part B claims for Initial Preventive Physical Examinations (IPPEs) and Annual Wellness Visits (AWVs). You’re encouraged to use the data-driven tables to compare your billing and payment patterns with your peers in your state and across the nation.
Introduction (Initial Preventive Physical Examinations and Annual Wellness Visits)
CBR202102 focuses on providers that submitted claims for IPPEs and AWVs using Healthcare Common Procedure Coding System (HCPCS) codes G0402, G0438, and G0439.
The 2020 Medicare Fee-for-Service Supplemental Improper Payment Data report shows an improper payment rate of 29.5% for the HCPCS code G0439, which represents $192,677,982 in possible improper payments.
The CBR was created to show the details of claims of the services provided on dates of service surrounding IPPE/AWV services. The report is not an indication of wrongdoing and does not require any action. However, it can support internal compliance review efforts, especially those related to coding and billing of code sets.
The criteria for receiving a CBR are as follows:
• A provider’s billing pattern is significantly higher compared to either state or national averages or percentages in any of the two metrics (i.e., greater than or equal to the 90th percentile)
• The provider has, at least, 8 beneficiaries with claims and, at least, $1,300 in total allowed charges for HCPCS code G0402, or at least, 13 beneficiaries with claims and, at least, $2,000 in total allowed charges for G0438, or at least, 94 beneficiaries with claims and, at least, $10,000 in total allowed charges for G0439.
The CBR is not available to the public. To access your report, look for an email from cbrpepper.noreply@religroupinc.com. You may have to update your email address in the Provider Enrollment, Chain, and Ownership System to ensure delivery.
Also, you can visit the secure CBR portal at https://cbrfile.cbrpepper.org/ to access an electronic copy of your CBR.
Other CBR samples can be viewed here.
NGS Medicare Administrative Contractor has mailed CBRs to healthcare providers for the following services:
JK Part B (Connecticut, Maine, Massachusetts, New Hampshire, New York, Rhode Island, and Vermont)
• Chiropractic Services (98940-98942)
• Hospital Outpatient Observation Services (99224-99226)
• Subsequent Hospital Visits (99231-99233)
• Chronic Care Management Service (99490 & 99487)
• Nursing Home Visits (99309-99310)
• Urine Drug Test(s) (80307)
• Physical and Occupational Therapy (97161-97163) and (97165-97167)
