Comparative Billing Reports

CBR201612 Statistical Debriefing

CBR201612

The following is a description of the tables used in CBR201612 Positive Airway Pressure Devices and Respiratory Assist Devices and Accessories. Links are available that allow access to the excel files that contain the state and national statistics used in the analysis of Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) claims submitted by the rendering suppliers. All of the analyses in this Comparative Billing Report (CBR) include only the Healthcare Common Procedure Coding System (HCPCS) codes covered in CBR201612 from claims submitted with dates of service from January 1, 2015 to December 31, 2015. These analyses are based on the latest version of claims available from the Integrated Data Repository (IDR), as of June 30, 2016. Examples of each table can be found in the CBR201612 sample.

 

HCPCS Codes and Abbreviated Descriptions

Table 1 of CBR201612 provides a listing of the categories, HCPCS codes, and abbreviated descriptions of each code included in this CBR.

 

Summary of Your Utilization

Table 2 provides a summary of your utilization of the HCPCS codes and categories included in this CBR. The total allowed charges, allowed services and distinct beneficiary count are included for each HCPCS code and category subtotal. In addition, an overall “Total” row is included. Please note that the subtotals and total may not be equal to the sum of the rows. The number of beneficiaries is an unduplicated count for each row, subtotal, and total. Since it is likely that a beneficiary would have billings for more than one HCPCS code, he/she would be counted in the beneficiary count in each applicable row. However, this beneficiary would be counted only once in the subtotal and total.

 

Average Allowed Services per Beneficiary by Category

Table 3 provides an analysis of the average allowed services per beneficiary by category. This average is calculated as the total allowed services by category divided by the total number of beneficiaries with allowed services by category. Each supplier’s percentage is compared to his state and the nation using the t-test at the alpha value of 0.05.

To view the average allowed services per beneficiary by category for each state and the nation, please select the following link: CBR201612 Average Allowed Services per Beneficiary by Category.xls.

 

Percentage of Allowed Services for Most Costly HCPCS Code by Selected Categories

Table 4 provides an analysis of the percentage of allowed services for most costly HCPCS code by selected categories. Several of the categories analyzed in the report have HCPCS codes that are more costly than the other codes in the category, and the data indicates that there is sufficient variation among the suppliers billing practices. This percentage is calculated as the total allowed services for most costly HCPCS codes by category divided by the total allowed services for the category and then multiplied by 100. Each supplier’s percentage is compared to his state and the nation using the chi-square test at the alpha value of 0.05.

 

To view the percentages of allowed services for most costly HCPCS code by selected categories for all states and the nation, please select the following link: CBR201612 Percentage of Allowed Services for Most Costly HCPCS Code by Selected Categories.xls.

 

Average Allowed Charges per Beneficiary

Table 5 provides an analysis of the average allowed charges per beneficiary. It is calculated as the total allowed charges divided by the total number of beneficiaries. The calculation includes all allowed charges and beneficiaries for the HCPCS codes included in this CBR for the services allowed with dates of service January 1, 2015 – December 31, 2015. Each supplier’s percentage is compared to his state and the nation using the t-test at the alpha value of 0.05.

 

To view the average allowed charges per beneficiary for each state and the nation, please select the following link: CBR201612 Average Allowed Charges per Beneficiary.xls.