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Comparative Billing Reports: Tools to support Medicare Part B providers

Kimberly Hrehor (kimberly.hrehor@religroupinc.com) is Program Director and Annie Barnaby is Outreach and Education Specialist at RELI Group Inc. in Catonsville, MD.

How do your billing and/or prescribing submissions compare to those of your peers? Even the most compliant process can benefit from comparisons and analyses of claims, billing, and/or prescribing data. To evaluate these data, develop provider education, and raise awareness of peer claim submission patterns, the Centers for Medicare & Medicaid Services (CMS) initiated the Comparative Billing Report (CBR) program in 2010.

More generally, CMS designed CBRs to protect the Medicare Trust Fund by focusing on areas that may be vulnerable to compliance, billing, and/or prescribing issues.[1] To this end, the CBR team identifies clinical areas with the potential to significantly affect the Medicare Trust Fund, analyzes claims data associated with those areas, and generates individualized CBRs for providers. Each CBR summarizes one provider’s Medicare claims data statistics and offers peer comparison data, making it an educational resource and tool that the provider can use for possible improvement.

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