Comparative Billing Reports

CBR201806 Statistical Debriefing

CBR201806

The following is a description of the metrics and tables presented in CBR201806 Independent Diagnostic Testing Facilities (IDTFs) Referring Providers, and the corresponding peer group statistics used for the comparisons. The analyses in this Comparative Billing Report (CBR) focuses on providers listed as the “Referring NPI” on Medicare Part B claims. This analysis includes claims with a rendering specialty of IDTF (47) and with dates of service from January 1, 2017 to December 31, 2017 based on the latest version of claims available from the Integrated Data Repository as of May 16, 2018. Below are examples of each table published in the CBR201806 sample CBR.

 

Table 1: Summary of Your Referrals to IDTFs

 

Table 1 provides a summary of your referrals to IDTFs. The table shows the number of services, the number of beneficiaries, and the total charges from January 1, 2017 to December 31, 2017. Below is an example of Table 1 from the CBR sample.

 

Table 1: Mock Summary of Your Referrals to IDTFs

Dates of Service: January 1, 2017 – December 31, 2017

Services

285

Beneficiaries

134

Charges

$51,791

 

For this mock provider, the table indicates that he/she has referred 134 beneficiaries to IDTFs resulting in 285 services billed and charges of $51,791.

 

Table 2: Percentage of Services without a Visit to the Referring Provider within 90 Days Prior to the IDTF Service Date

 

Table 2 provides a statistical analysis of the percentage of services without a visit to the referring provider within 90 days prior to the IDTF service date. The metric is calculated as follows:

 

(   ) x 100

 

Each provider’s percentage is compared to his/her specialty 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 2: Mock Percentage of Services without a Visit to the Referring Provider within 90

                                               Days Prior to the IDTF Service Date                

Dates of Service: January 1, 2017 – December 31, 2017

Number of Services without a Visit

Total Number of Services

Your Percent

Your Specialty’s Percent

Comparison with Specialty’s Percent

National

Percent

Comparison with National Percent

18

285

6%

15%

Does Not Exceed

21%

Does Not Exceed

 

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

 

In this example, the mock provider has referred 285 services. Of these, 18 services were for beneficiaries who did not visit the referring provider in the 90 days prior to the IDTF service date. The division of 18 by 285, and multiplying by 100, will equate to his percentage of 6 percent. In this example, the provider “Does Not Exceed” either his specialty’s or the national percentages, according to the chi-square test.

 

To view the percentage of services without a visit to the referring provider within 90 days prior to the IDTF service date for each specialty and the nation, please select the following link: CBR201806 Percentage of Services without a Visit to the Referring Provider.xls.

 

Table 3: Percentage of Services without a Similar Diagnosis within 90 Days Prior to the IDTF Service Date

 

Table 3 provides a statistical analysis of the percentage of services without a similar diagnosis within 90 days prior to the IDTF service date. The metric is calculated as follows:

 

         (   ) x 100

 

The diagnosis category, or the first three characters of the ICD-10 diagnosis code, was used to define a similar diagnosis. All diagnoses submitted on Medicare Part B claims, from all providers with service dates within 90 days prior to the IDTF service date, were compared to the line diagnosis on the IDTF claim. The referring provider or any other provider who does not have a specialty of IDTF could have submitted the corresponding claim with a similar diagnosis. Each provider’s percentage is compared to his/her specialty 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: Mock Percentage of Services without a Similar Diagnosis within 90 Days

Prior to the IDTF Service Date

Dates of Service: January 1, 2017 – December 31, 2017

Number of Services without a Similar Diagnosis

Total Number of Services

Your Percent

Your Specialty’s Percent

Comparison with Specialty’s Percent

National

Percent

Comparison with National Percent

200

285

70%

45%

Significantly Higher

39%

Significantly Higher

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

 

In this example, the mock provider has referred 200 services, out of a total of 285 services, without a similar diagnosis. The division of 200 by 285, and multiplying by 100, will equate to the mock provider’s percentage of 70 percent. In this example, the provider is “Significantly Higher” than both the specialty’s and the national percentages, according to the chi-square test.

 

To view the percentage of services without a similar diagnosis within 90 days prior to the IDTF service date for each specialty and the nation, please select the following link: CBR201806 Percentage of Services without a Similar Diagnosis.xls.

 

Table 4: Average Allowed Charges per Beneficiary

 

Table 4 provides a statistical analysis of the average allowed charges per beneficiary for the one-year period. This average is calculated as follows:

 

 

Each provider’s average is compared to his/her specialty 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: Mock Average Allowed Charges per Beneficiary

Dates of Service: January 1, 2017 – December 31, 2017

Total Charges

Total Number of Beneficiaries

Your Average

Your Specialty’s Average

Comparison with Specialty’s Average

National

Average

Comparison with National Average

$51,791.10

134

$386.50

$320.46

Significantly Higher

$373.59

Higher

 

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

 

This mock provider has IDTF referrals totaling $51,791.10. This covers 134 beneficiaries. Dividing $51,791.10 by 134 beneficiaries yields this mock provider’s average per beneficiary of $386.50. The t-test indicates that this mock provider’s average is “Significantly Higher” than that of the specialty, and “Higher” than the national peer group.

 

To view the average allowed charges per beneficiary for each specialty and the nation, please select the following link: CBR201806 Average Allowed Charges per Beneficiary.xls.