The following is a comprehensive description of the tables used in CBR201401, positive airway pressure (PAP) devices and accessories. There are links that will open excel files that contain state and national statistics used in the analysis of billing practices for CBR201401. Please refer to Table 1 in the sample CBR201401 for a listing of the Healthcare Common Procedure Coding System (HCPCS) Codes used in each of the categories analyzed in the comparative billing report.

In the sample CBR201401, Table 3 refers to the summary of allowed charges and the percentage change in allowed charges for the two time periods listed in the table. The allowed charge is the total amount that Medicare allows, based on the DMEPOS regional fee schedule for the HCPCS Code listed on the claim. Table 3 contains a summary by six categories and a total which are listed on the left side of the table. The supplier’s allowed charges for each time period and the percent changes for the supplier, state and nation are listed on the top of the table. The percent change is calculated as the difference between the allowed charges for July 2012-June 2013 minus the allowed charges for July 2010-2011 divided by the allowed charges for July 2010-June 2011, multiplied by 100. This same calculation applying state and national allowed charges for the same time periods is used to compute the percent change for the state and the nation. These calculations are supplied in Table 3 for each category and the total. Since this a sample CBR, this table contains only the statistics for the state where the supplier is located and the national statistics.

To view the percentage change in allowed charges statistics for all states and the nation, please select the following link: Percentage Change in Allowed Charges Statistics

This table contains the percentage change in allowed charges for each state and the nation for each category and total. In the interest of space constraints and formatting, this table lists the states along the left side and the categories along the top of the spreadsheet.

The sample CBR201401 contains Table 4 which is a comparison of the average services per beneficiary per year for each HCPCS category. The categories are listed along the left of the table, with the averages and comparisons along the top of the table. The average services per beneficiary is calculated as the total allowed services divided by the total number of beneficiaries with allowed services for claims with dates of service for the year between July 2012 and June 2013. An allowed service is defined as a submitted service that Medicare has granted an allowed charge greater than zero. This same calculation applying state and national allowed services and beneficiary counts is used to compute the average services per beneficiary for the state and the nation. These calculations are supplied in Table 4 for each category and the total. The comparison with the state and national averages is also displayed in the table as either “Higher” or “Does Not Exceed.” These comparisons are based on the results of the statistical test known as a t-test. The t-test was used to give the supplier the benefit of the doubt if the quantity of allowed claims was very low. It is not uncommon to see the comparison listed as “Does Not Exceed” even though the supplier’s average is greater than the average of the peer group. “Does Not Exceed” would be listed if the supplier’s average was less than that of his peers, or if the supplier has only a few beneficiaries in this category. Since this is a sample CBR, this table compares the individual supplier’s information only with the statistics for the state where the supplier is located and the national statistics.

To view the average services per beneficiary statistics for all states and the nation, please select the following link: Average Services Per Beneficiary Statistics

This table contains the average services per beneficiary for each state and the nation for each category. In the interest of space constraints and formatting, this table lists the states along the left side and the categories along the top of the spreadsheet.

Table 5, of the sample CBR201401, compares the percentage of the most costly items in the selected categories for the supplier to the state and national percentages. The categories and the specific HCPCS Codes of the most costly items in that category are listed along the left side of the table. The percentage of allowed services and the comparisons to the state and nation are listed along the top of the table. The percentage of allowed services for the most costly HCPCS codes within each category is calculated as the total allowed services for the most costly HCPCS code(s) divided by the total allowed services for the entire category, multiplied by 100. For example, for the category of filters, the total allowed services for HCPCS code A7039 (the most costly item in this category) is computed and that figure is divided by the total allowed services for all HCPCS codes in the filters category (A7038 and A7039), multiplied by 100 to obtain this percent. This calculation is made for each of the categories listed in the table, using the HCPCS Codes listed in the most costly item column and the total HCPCS Codes for the category, as listed in Table 1, of the sample CBR201401. This same calculation, applying state and national allowed services, is used to compute the percentage of the most costly items for the state and the nation. These calculations are supplied in Table 5 for each category. The comparison with the state and national percentages is displayed in the table as either “Higher” or “Does Not Exceed.” These comparisons are based on the results of the statistical test known as a chi-square test. The chi-square test was used to give the supplier the benefit of the doubt if the quantity of allowed claims was very low. It is not uncommon to see the comparison listed as “Does Not Exceed” even though the supplier’s percentage is greater than the percentage of the peer group. “Does Not Exceed” would be listed if the supplier’s percentage was less than that of his peers, or if the supplier has only a few allowed services in this category. Since this is a sample CBR, this table compares the individual supplier’s information only with the statistics for the state where the supplier is located and the national statistics.

To view the percentage of most costly items statistics for all states and the nation, please select the following link: Percentage of Most Costly Items

This table contains the percentage for each state and the nation for each category. In the interest of space constraints and formatting, this table lists the states along the left side and the categories along the top of the spreadsheet.

Note: The data included on this page and in the provided downloadable files is intended for educational and reference purposes only and is not available for redistribution. Please refer all individuals to the CBR website or the CBR Support Help Desk for more information.