Comparative Billing Reports

CBR201802 Statistical Debriefing

CBR201802

The following is a description of the metrics and tables presented in CBR201802, Spinal Orthoses Referring Providers, and the corresponding peer group statistics used for the comparisons. The analyses in this Comparative Billing Report (CBR) focus on the Healthcare Common Procedure Coding System (HCPCS) codes for custom-fitted and off-the-shelf prefabricated spinal orthoses. CBR201802 includes Medicare Part B, Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) claims with dates of service from October 1, 2016 to September 30, 2017. These analyses are based on the latest version of claims available from the Integrated Data Repository as of January 24, 2018. Below are examples of each table published in the CBR201802 sample.

Table 1: Summary of Your Referrals for Spinal Orthoses Dates of Service: October 1, 2016 – September 30, 2017

 

Type

HCPCS Code

   Allowed

   Charges

Allowed

Services

Beneficiary

Count

Custom-Fitted

L0627

 

$0

0

0

Custom-Fitted

L0631

$0

0

0

Custom-Fitted

L0637

$23,747

21

21

Off-the-Shelf

L0642

$0

0

0

Off-the-Shelf

L0648

$17,267

18

18

Off-the-Shelf

L0650

$18,075

16

16

 

Total

$59,089

55

55

 

For this mock provider, the table indicates that he/she has referred total allowed charges of $59,089 for the six HCPCS codes included in the study.  This mock provider has referred 55 spinal orthoses to 55 beneficiaries.

 

Please note that the totals may not be equal to the sum of the rows due to rounding. Also, the beneficiary count is an unduplicated count for each row and the total. For example, a beneficiary receiving multiple services with different 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.

Table 2: Percentage of Allowed Services Defined as Custom-Fitted

Table 2 provides a statistical analysis of the percentage of allowed services defined as custom-fitted (HCPCS code L0627, L0631, and L0637).
 

This metric is calculated as the number of spinal orthoses submitted with HCPCS codes L0627, L0631, and L0637 divided by the total number of spinal orthoses services that are included in the study, and then multiplied 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. Below is an example of table 2 and the results of this analysis from our mock provider.
 

Table 2: Percentage of Services Defined as Custom-Fitted
Dates of Service: October 1, 2016 – September 30, 2017

Number of Custom-Fitted

Services

Total Number of Services

Your Percent

Your State’s Percent

Comparison with

Your State

National Percent

Comparison with National Percent

21

55

38%

14%

Significantly Higher

17%

Significantly Higher

A chi-square test was used in this analysis, alpha = 0.05

 

In this example, the mock provider has referred 21 services that are defined as custom-fitted, out of a total of 55 services. Dividing 21 by 55, and multiplying by 100, will yield his/her percentage of 38 percent. The state’s percentage is 14 percent, and the national percentage is 17 percent. The statistical test used in this analysis, chi-square test, presents this provider’s percentage as “Significantly Higher” than both the state’s and national percentages.

 

It is important to note that the significance, determined by the statistical test, is based on not only the differences in the values, but also the number of observations and the variability of those observations.  Generally, the higher the number of observations, the better the statistical test is able to detect significance.

 

To view the percentage of allowed services defined as custom-fitted for each state and the nation, please select the following link: CBR201802 Percentage of Allowed Services Defined as Custom-Fitted.xls.

 

Table 3: Percentage of Allowed Services Submitted without a Visit to the Referring Provider within 90 Days of the DMEPOS Service Date

Table 3 provides a statistical analysis of the percentage of allowed services submitted without a visit to the referring provider within 90 days of the DMEPOS service date. The service date is defined as the date that the spinal orthosis order was filled by the DMEPOS supplier.

 

The percentage is calculated as the number of services without a visit to the referring provider within 90 days of the spinal orthosis service date, divided by the total number of services, and then multiplied 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. Below is an example of the results of this analysis.

 

              Table 3: Percentage of Services without Visit to Referring Provider                                                 Dates of Service: October 1, 2016 – September 30, 2017

Number of Services without Visit

Total Number of Services

Your Percent

Your State’s Percent

Comparison with

Your State

National Percent

Comparison with National Percent

3

55

5%

53%

Does Not Exceed

51%

Does Not Exceed

A chi-square test was used in this analysis, alpha = 0.05

 

To view the percentage of allowed services submitted without a visit to the referring provider within 90 days of the DMEPOS service date for each state and the nation, please select the following link: CBR201802 Percentage of Allowed Services Submitted without a Visit to the Referring Provider within 90 Days of the DMEPOS Service date.xls

 

Table 4: Average Allowed Charges per Beneficiary for the One-Year Period

Table 4 provides a statistical analysis of the average allowed charges per beneficiary for the one-year period.

 

This statistic is calculated as the total allowed charges for the six spinal orthoses codes in this CBR, divided by the 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. Table 4 is an example of the results of this analysis.

 

                        Table 4: Average Allowed Charges per Beneficiary
                   Dates of Service: October 1, 2016 – September 30, 2017

Total Charges

Total Number Beneficiaries

Your Average

Your State’s Average

Comparison with

Your State

National Average

Comparison with National Average

$59,089.11

55

$1,074.35

$924.00

Significantly Higher

$1,043.58

Significantly Higher

A t-test was used in this analysis, alpha = 0.05

 

This mock provider has referrals totaling $59,089.11 for the spinal orthoses included in this CBR.  This covers 55 beneficiaries.  Dividing $59,089.11 by 55 beneficiaries yields this mock provider’s average per beneficiary of $1,074.35. The t-test indicates that this mock provider’s average is “Significantly Higher” than both the state’s and the national averages.

 

To view the average allowed charges per beneficiary for the one-year period for each state and the nation, please select the following link: CBR201802 Average Allowed Charges per Beneficiary for the One-Year Period.xls