Comparative Billing Reports

CBR201803 Statistical Debriefing

CBR201803

The following is a description of the metrics and samples of the tables presented in CBR201803, Spinal Orthoses Suppliers, 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. CBR201803 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 CBR201803 sample for a mock suppler.

Table 1: Summary of Your Utilization for Spinal Orthoses

Table 1 provides a summary of the individual supplier’s utilization for the HCPCS codes included in the CBR. Below is an example of table 1 from the CBR sample:
 

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

 

Type

HCPCS Code

   Allowed

   Charges

Allowed

Services

Beneficiary

Count

Custom-Fitted

L0627

 99211

$9,594

25

25

Custom-Fitted

L0631

$56,640

60

60

Custom-Fitted

L0637

$3812

1

1

Off-the-Shelf

L0642

$1,926

5

5

Off-the-Shelf

L0648

$35,619

37

36

Off-the-Shelf

L0650

$0

0

0

 

Total

$107,591

218

127

 

For this mock provider, the table indicates that he/she has total allowed charges of $107,591 for the six HCPCS codes included in the study.  This mock supplier has 218 spinal orthoses submitted for 127 beneficiaries.

Statistics were calculated for each supplier and the two peer groups, national specialty group and DME MAC/specialty group (see appendix for more information). Based on the information obtained from the claims, this mock supplier has been assigned to specialty group Physician/Nonphysician Likely to Have Orthotist Training and the DME MAC jurisdiction JA. Each supplier’s values are compared to his/her peer group values.
 

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 supplier’s percentage is compared to his/her DME MAC/specialty group and national specialty group using the chi-square test at the alpha value of 0.05. Below are an example of table 2 and the results of this analysis from our mock supplier.

 

Table 2: Mock 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

DME MAC / Specialty Group’s Percent

Comparison with

DME MAC / Specialty Group

National

Specialty Group Percent

Comparison with National Specialty Group

86

128

67%

35%

Significantly Higher

38%

Significantly Higher

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

 

In this example, the mock supplier has 86 services that are defined as custom-fitted, out of a total of 128 services. Dividing 86 by 128, and multiplying by 100, will yield his/her percentage of 67 percent. The DME MAC/specialty group percentage is 35 percent, and the national specialty group percentage is 38 percent. The statistical test used in this analysis, chi-square test, presents this supplier’s percentage as “Significantly Higher” than both peer group 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 percentages of allowed services defined as custom-fitted for each DME MAC specialty and national specialty please select the following link: CBR201803 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 supplier’s percentage is compared to his/her DME MAC/specialty group and national specialty group, using the chi-square test at the alpha value of 0.05. Below is an example of the results of this analysis.

 

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

Number of Services without Visit

Total Number of Services

Your Percent

DME MAC / Specialty Group’s Percent

Comparison with

DME MAC / Specialty Group

National

Specialty Group Percent

Comparison with National Specialty Group

47

218

37%

14%

Significantly Higher

20%

Significantly Higher

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

 

In this example, the mock supplier has 47 services, out of a total of 128 services, without a visit to the provider within 90 days of the spinal orthosis service date. The division of 47 by 128, and multiplying by 100, will equate to his percentage of 37 percent. In this example, the supplier’s percentage is “Significantly Higher” than both of the peer group percentages, according to the chi-square test.

To view the percentage of allowed services submitted without a visit to the referring provider within 90 days of the DMEPOS service date for DME MAC/specialty and national specialty, please select the following link: 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 supplier’s average is compared to his/her DME MAC/specialty group and national specialty group using the t-test at the alpha value of 0.05. Table 4 is an example of the results of this analysis.

 

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

Total Charges

Total Number Beneficiaries

Your Average

DME MAC / Specialty Group’s  Average

Comparison with

DME MAC / Specialty Group

National

Specialty Group  Average

Comparison with National Specialty Group

$107,590.85

127

 $847.17

$740.18

Significantly Higher

$938.52

Does Not Exceed

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

 

This mock supplier has allowed charges totaling $107,590.85 for the spinal orthoses included in this CBR.  This covers 127 beneficiaries.  Dividing $107,590.85 by 127 beneficiaries yields this mock supplier’s average allowed charges per beneficiary of $847.17. The t-test indicates that this mock supplier’s average is “Significantly Higher” than the DME MAC/specialty group’s average but “Does Not Exceed” the average for the national specialty group.

To view the average allowed charges per beneficiary for the one-year period for each DME MAC/specialty group and national specialty, please select the following link: CBR201803 Average Allowed Charges per Beneficiary for the One-Year Period.xls.

 

Peer Groups for Comparison

In an effort to define peer groups for general comparison purposes, DMEPOS suppliers and physicians/nonphysicians were assigned to one of the four following specialty groups.  These groupings were made to better define a national peer group and are based on the likelihood that a particular supplier has the necessary orthotist training to make the modifications to custom-fitted spinal orthoses at the time of delivery. Specialty groups were assigned from the Medicare specialty code obtained from the claim as defined below. If a supplier reported multiple specialties, then the specialty group with the highest allowed charges was used to assign the peer group.  Each supplier was compared to all other suppliers across the nation with the specialty group designation and to those within the DME MAC jurisdiction and specialty group.

DMEPOS Supplier Not Likely to Have Orthotist Training

A6

Medical Supply Co with Respiratory Therapist

B1

Oxygen Supplier

54

Medical Supply Co - Other

58

Medical Supply Co with Registered Pharmacist

63

Portable X-Ray Supplier

87 All Other Suppliers

 

DMEPOS Supplier Likely to Have Orthotist Training

B3

Medical Supply Co with Pedorthic Personnel

51

Medical Supply Co with Certified Orthotic Personnel

52

Medical Supply Co with Certified Prosthetic Personnel

53

Medical Supply Co with Prosthetic/Orthotic Personnel

 

Physician/Nonphysician Not Likely to Have Orthotist Training

A0

Hospital

30

Diagnostic Radiology

 

A5

Pharmacy

40

Hand Surgery

 

01

General Practice

41

Optometry (LLP)

 

02

General Surgery

48

Podiatry (LLP)

 

04

Otolaryngology

50

Nurse Practitioner

 

05

Anesthesiology

66

Rheumatology

 

08

Family Practice

84

Preventive Medicine

 

11

Internal Medicine

93

Emergency Medicine

 

16

Obstetrics/Gynecology

94

Interventional Radiology

 

19

Oral Surgery (Dentists only) (LLP)

99

Unknown Physician Specialty

 

           

 

Physician/Nonphysician Likely to Have Orthotist Training

B2

Pedorthic  Personnel

55

Individual Orthotic Personnel

 

12

Osteopathic Manipulative Medicine

56

Individual Prosthetic Personnel

 

13

Neurology

57 Individual Prosthetic/Orthotic Personnel

 

14

Neurosurgery

65

Physical Therapist in Private Practice

20

Orthopedic Surgery

67

Occupational Therapist in Private Practice

23

Sports Medicine

70

Single or Multispecialty Clinic or Group Practice

25

Physical Medicine and Rehabilitation

72

Pain Management

35

Chiropractic (LLP)