Comparative Billing Reports

General CBR FAQs

The following questions represent frequently asked questions (FAQs) from the provider community on Comparative Billing Reports (CBRs) and the CBR project in general. FAQs pertaining to a specific CBR release or billing topic are located on that specific CBR release page. Specific CBR release pages can be found on the All CBRs page. You can also navigate to each individual FAQs page using the CBR Releases Navigation bar at the top of this page.

 

What is a CBR?

A Comparative Billing Report (CBR) provides comparative data on how an individual health care provider varies from other providers in the same area. CBRs help the Centers for Medicare & Medicaid Services (CMS) address potential over-utilization in the Medicare Fee-For-Service (FFS) program.

 

CBRs contain data-driven tables and graphs that contain an explanation of findings comparing providers' billing and payment patterns to those of their peers in the state and across the nation. The goal of these reports is to offer a tool that helps providers better understand applicable Medicare billing rules and improve the level of care they provide to their Medicare patients.

 

For a listing of fees used by Medicare to pay providers, please see the Fee Schedules on the CMS website located at http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/FeeScheduleGenInfo/index.html.

 

Why am I getting this report?

CMS employs various strategies in its effort to ensure accurate coding. The production of CBRs is an educational tool that aids in this effort.

 

I have a question about the CBR I received. Who should I contact?

For all CBR-related questions, please contact the CBR Support Help Desk at 1-800-771-4430 or email CBRsupport@eglobaltech.com.

 

What is the policy reference for this report?

The policy references for each CBR billing topic can be found under the references section of the related CBR Release.

 

Can I get specific claim data related to this report?

All of the specific information related to the CBR is listed under the results section in your report.

 

I have a question about my claims.

Your Medicare Administrative Contractor (MAC) can assist you with questions about a specific claim or if you identify any claims discrepancies while reviewing your CBR. To obtain the contact information for your MAC as well as CMS’ other review contractors, please access the CMS Review Contractor Directory Interactive Map at http://go.cms.gov/IMap.

 

The address on the letter is no longer current.  Can you correct your files?

The CBR Team uses the mailing address on file in the Provider Enrollment, Chain, and Ownership System (PECOS), and the fax number on file in the National Plan and Provider Enumeration System (NPPES). If you have changed your mailing address or contact information, please take the time to review and update NPPES and PECOS.

If a provider or supplier would like to receive a CBR at an address or fax not listed in PECOS or NPPES, please contact the CBR Support Help Desk by calling 1-800-771-4430 or emailing CBRsupport@eglobaltech.com.

 

How do I change my communication method preference for receiving CBRs?

At this time, CBRs are disseminated to providers/suppliers via fax or U.S. postal mail. If you would like to change your communication method preference, please contact the CBR Support Help Desk by calling 1-800-771-4430 or emailing CBRsupport@eglobaltech.com.

 

I did not receive a CBR.  Can I request one?

Custom requested CBRs are not available at this time.  Please contact the CBR Support Help Desk by calling 1-800-771-4430 or emailing CBRSupport@eglobaltech.com for more information.

 

How will I know if I am on the list of providers/suppliers to receive a CBR?

Please contact the CBR Support Help Desk by calling 1-800-771-4430 or emailing CBRsupport@eglobaltech.com with your inquiry. You will need to provide your name and National Provider Identifier (NPI).

 

Is there a sample CBR that I can view?

Yes, a sample is provided for each CBR produced. You can access the sample CBR for each CBR release on the individual CBR release pages.

 

Can I suggest a topic to study?

We appreciate your suggestions for additional study topics. Please email your suggestions to the CBR Support Help Desk at CBRsupport@eglobaltech.com.

 

I am a hospital.  Would I be able to receive this report?

No, hospitals will not receive a CBR. Hospital-related comparative reports are performed for CMS by TMF Health Quality Institute and are known as the Program for Evaluating Payment Patterns Electronic Report (PEPPER) reports.

 

What is a t-test?  What does it mean?

A t-test is a statistical test that can be used to compare your average with that of your peers. This test is used to determine if the averages from two sets of data are significantly different from each other, and is most commonly applied when the test statistic follows a normal distribution. The test is used to support or reject the null hypothesis that the averages from the two sets of data are equal. Significance for the t-test is based on the number of data points and the variability of that data.

 

What breakpoint is used to determine the difference between a comparison of “higher” and “significantly higher?”

Unfortunately, we are not able to provide an exact breakpoint (percentage or average) that a provider would need to warrant a comparison of “higher” as opposed to “significantly higher.” Significance is determined by the results of the chi-square test or t-test which involves calculations based on the total number of services and the variation of those services of each individual provider’s data.

 

What is a chi square test?  What does it mean?

A chi-square test is a statistical test on distribution of categorical data. It can be used to compare your distribution with what we would expect based on the distribution of your peers. The test is used to support or reject the null hypothesis that the distributions of the two sets of data are equal. Significances for the chi square test are based on the number of data points and the categorical proportions of that data.

 

What is alpha and p-value?  What does it mean?

Alpha value is the value at which we are determining statistical significance. An alpha value of .05 means that there is a 5% chance that the difference between your value and that of your peers is observed purely by chance. P-values are calculated and compared to the alpha value to determine if the difference is significant. There are two outcomes to the ‘t-test’ and ‘chi-square test’; 1) An individual provider’s utilization measure is significantly higher, or 2) does not exceed that of the peer group. The results of statistical significance for each measure will be displayed in a table.

 

What is the difference between the Figure and the Table?

In general, a Figure is a graphic representation of the same data represented in a Table. Additionally, a Table may show the difference and the statistical significance of your data in comparison to your peers.

 

Why is the website link for Local Coverage Determinations (LCDs) and/or Local Coverage Articles (LCAs) not working?

CMS is continuously updating its website and may have retired or superseded a LCD or LCA. In this case, providers and suppliers can check the CMS Medicare Coverage Database archives to view the LCD or LCA.

 

How are allowed charges calculated?

The allowed charges are taken from the Medicare Physicians Fee Schedule Database and can vary depending on the carrier locality, the type of facility the service was rendered in, the number of units billed and the use of a modifier. Providers who participate in Medicare agree to accept the Medicare allowed amount as the total amount of payment for the service they provide.  In most instances, Medicare pays the provider 80% of the fee schedule allowed amount and the patient is responsible for the balance of the payment. There are some exceptions to this rule.

 

My allowed charges are higher than that of the nation.  Is this because I am in a region with a higher allowed amount such as San Francisco, California?

The Medicare Physician Fee Schedule allowed amounts vary from area to area.  A geographic practice cost index (GPCI) has been established to account for the variation in practice expenses across the states and nation. Our CBRs contain comparisons to the state as well as the nation. State comparisons may provide a better indication for significance. Please contact your MAC if you have specific questions related to allowed charges for your region.

 

Can I receive continuing education units (CEUs) for attending a CBR webinar?

No. The Centers for Medicare & Medicaid Services (CMS) is not offering CEU credits for attending a CBR webinar. Information related to CEU credits is located on the CMS website at http://www.cms.gov/Outreach-and-Education/Outreach/NPC/CEC_Notification.html.

 

Does CMS determine the CBR topics and generate the CBRs?

CMS has contracted the firm, eGlobalTech (eGT) to administer the CBR program. CMS approves all CBR topics and provides access to necessary information and data. eGT and its partner, Palmetto GBA, are responsible for analyzing data, researching, developing, and disseminating the CBRs. Additional information about eGT is available at www.eglobaltech.com. For more information about Palmetto GBA, visit www.palmettogba.com/medicare.

 

Will there be a downloadable handout of the webinar?

Yes. A downloadable version of the handout will be available within 14 days after each of the webinars on our CBR website, located at http://cbrinfo.net/education.html. From this link, select the webinar topic you desire, where you will find links to the webinar handout and the question and answer document.

 

I was not able to attend the scheduled webinar. Is another webinar scheduled on this subject or can I hear a recording of the webinar?

An MP4 recording of the audio and video of the entire presentation is available within 5 days after each webinar. You can select specific sections of a webinar, or listen to an entire webinar by logging on to the CBR website page at http://cbrinfo.net/education.html. From this link, you can choose the webinar and recording that you want to view/hear.

 

I did not hear an answer to the question I asked during the webinar. Will I receive a response to my question?

Due to time constraints, we cannot answer all of the questions asked during the webinars. However, all questions and answers from each webinar, as well as any questions that we were not able to address, will be answered and posted in detailed Q & A documents. These, along with handouts, will be posted to our website within 14 days of each webinar. To access these documents, please visit http://cbrinfo.net/education.html and select the webinar topic, where you will find a link to the Q & A document. If you need additional assistance, please contact the CBR Support Help Desk at 1-800-771-4430 or email us at cbrsupport@eglobaltech.com.

 

How can I get a copy of the slides of the webinar?

The slides for each webinar will be available within 5 business days after the webinar. The slides are an outline only and do not contain any audio or speaker notes. The MP4 is more thorough, as it contains both the audio as well as the video of the entire presentation. The slides and the MP4 recordings of the webinars can be accessed at http://cbrinfo.net/education.html.