Comparative Billing Reports

CBR201706 Statistical Debriefing

CBR201706

The following is a description of the tables used in CBR201706, Drugs of Abuse Testing. There are links that will open excel files that contain state and national statistics used in the analysis of referring Part B providers for CBR201706. The procedures analyzed in this Comparative Billing Report (CBR) include presumptive tests using Healthcare Common Procedure Coding System (HCPCS) codes G0477 – G0479 and definitive tests using HCPCS codes G0480 – G0483. CBR201706 includes claims with dates of service from January 1, 2016 to December 31, 2016. These analyses are based on the latest version of claims available from the Integrated Data Repository as of June 7, 2017. Examples of each table can be found in the CBR201706 sample.

 

Summary of HCPCS Codes for Drugs of Abuse Testing

Table 1 of CBR201706 describes the type of drug testing and the method or number of drug classes tested for each HCPCS code.

 

Definitive Testing for Substance Use Disorder

Table 2 outlines the guidelines for definitive testing for substance abuse disorder (SUD).

 

Summary of Your Referrals of Presumptive and Definitive Tests

Table 3 provides a summary of your utilization of the procedure codes included in this CBR. The total charges, allowed services, distinct visits, and distinct beneficiary counts are included for each HCPCS code. In addition an overall “Total” is included. Please note that the totals may not be equal to the sum of the rows due to rounding. Also, the visit count and beneficiary count are unduplicated counts for each row and the total. For example, a beneficiary receiving multiple HCPCS codes within this time period would be counted in the beneficiary count in each applicable row; however, this beneficiary would be counted only once in the total row.

 

Percentage of Definitive Tests using G0483

Table 4 provides an analysis of the percentage of definitive tests using G0483. For definitive tests, it is important for the clinician to individualize his/her ordering practice to reflect the needs of the patient. In some cases, the most costly code is chosen too often. For definitive tests, the highest cost option is G0483. The percentage of definitive tests using HCPCS code G0483 is calculated by taking the number of G0483 services divided by the total number of definitive test services, and then multiplying by 100. Each provider’s percentage is compared to his/her state and the nation using the chi-square test at the alpha value of 0.05.

 

To view the percentage of definitive tests using G0483 for each state and the nation, please select the following link: CBR201706 Percentage of Definitive Tests using G0483.xls

 

Percentage of Services Ordered Too Frequently

Table 5 provides an analysis of the percentage of services ordered too frequently. There are guidelines that limit the amount of time between tests of the same type. In some cases, the frequency of the testing does not meet established guidelines. For this measure, services ordered too frequently are defined as presumptive test services performed within three days of the previous presumptive test and/or definitive test services performed within seven days of the previous definitive test. The percentage of services ordered too frequently is calculated by taking the number of services classified as ordered too frequently divided by total number of services, and then multiplying by 100. Each provider’s percentage is compared to his/her state and the nation using the chi-square test at the alpha value of 0.05.

 

To view the percentage of services ordered too frequently for each state and the nation, please select the following link: CBR201706 Percentage of Services Ordered Too Frequently.xls

 

Average Services per Beneficiary

Table 6 provides an analysis of the average services per beneficiary. The average allowed services per beneficiary was calculated for each referring provider of drug testing services to identify potential over- utilization of these items. This measure considers all allowed services for with dates of services in 2016. The average number of services per beneficiary is calculated by taking the total number of services divided by total number of beneficiaries. Each provider’s average is compared to his/her state and the nation using the t-test at the alpha value of 0.05.

 

To view the average services per beneficiary for each state and the nation, please select the following link: CBR201706 Average Services per Beneficiary.xls

 

Average Services per Visit

Table 7 provides an analysis of the average services per visit. The average allowed services per visit was calculated for each referring provider of drug testing services. This measure focuses on the number of services on a specific date of service for a beneficiary. This measure differs from the previous measure in that it focuses on the single date of service rather than the total number of services for the entire year. The average number of services per visit is calculated by taking the total number of services divided by total number of visits. Each provider’s average is compared to his/her state and the nation using the t-test at the alpha value of 0.05.

 

To view the average services per visit for each state and the nation, please select the following link: CBR201706 Average Services per Visit.xls