What Physicians and Practices Should Know about Medicare Comparative Billing Reports

Last Updated: Jan 22, 2020

Comparative Billing Reports (CBRs) are free, provider-specific reports that compare your billing and payment patterns to those of your peers in your state and across the nation. The Centers for Medicare and Medicaid Services (CMS) has contracted with RELI Group, Inc. along with its partners – TMF Health Quality Institute and CGS – to develop, produce, and distribute these reports. These FAQs created by RELI Group answer questions about the reports and explains how to access them.

Reports

What is a CBR?

A CBR is a free, educational tool that compares a Medicare provider’s billing and payment patterns to those of their peers. The comparisons are based on a state or clinical specialty level, in addition to a nationwide level. Receiving a CBR is not an indication of or precursor to an audit, and it requires no response from the provider. 

What are the benefits of a CBR? 

A CBR is intended to enhance accurate billing practices and support providers’ internal compliance activities. The benefits of a CBR review may include:

  • Support of the integrity of claims submission
  • Improvement in education, accuracy, and quality regarding coding and billing procedures
  • Early detection of outliers in billing processes
  • More complete documentation of patient care

When are CBRs distributed?  

CBRs are released on a regular basis throughout the year. The following CBRs have been produced and disseminated in 2019: 

  • Intensity-Modulated Radiation Therapy — Released in January
  • Office Visits, New and Established, Family Practitioners — Released in February
  • Subsequent Hospital Care — Released in March
  • Vitamin D Testing — Released in April
  • Air Ambulance Transports — Released in April
  • Emergency Department Services — Released in May
  • Modifier 25: Dermatology – Released in June
  • Breast Re-Excision – Released in July
  • Venipuncture – Released in August
  • Upper and Lower Endoscopy on Different Dates of Service – Released in September
  • Atherectomy Only as Initial Intervention – Released in October
  • Drug Units in Excess of MUE – Released in November
  • Mohs Microsurgery – Released in December

Additionally, a CBR on shoulder arthroscopy will be released on Jan. 27, 2020.

Who receives a CBR?

CBRs are distributed to providers when Medicare billing patterns differ from those of their peers. CBRs are mailed to provider addresses based on the contact information in the Provider Enrollment, Chain, and Ownership System (PECOS). Additionally, providers who have an email address or fax number listed will also receive electronic notification that a CBR is available for download via the CBR Portal. The National Plan and Provider Enumeration System (NPPES) is used as a secondary measure when contact information in PECOS is not listed.

Providers can contact the CBR Help Desk with questions or to clarify whether a CBR has been issued. Providers are reminded ensure their email address, fax number and mailing address are updated in the following systems: 

Additional information regarding CBRs, including sample CBRs, can be found on the CBR Home Page

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