In 2020, CMS stepped up the creation and distribution of Comparative Billing Reports (CBRs). These reports are designed to be educational and help providers understand their compliance with Medicare’s coding and billing guidelines. CBRs are sent by Medicare Administrative Contractors (MACs) to providers whose billing patterns fall outside expected patterns. Receiving a CBR does not indicate there is a problem, but it is a good indicator that there may be a problem and it is advisable to do some investigation.
While CBRs are periodically sent to providers, it is important for organizations to continuously monitor the billing patterns of their providers to assess compliance and payment risks, which is why many organizations adopt a platform such as MDaudit Enterprise. MDaudit Enterprise allows organizations to look at information similar to what you would see on a CBR across all payers. MDaudit’s Charge Analyzer gives you the ability to look at billing patterns for all the providers in your organization and compare their billing patterns to both the CMS National and MDaudit’s Customer Cohort Normalized data. Analyses can be run for any provider group, or provider, any time, for either E&Ms or procedural based codes, which can then be used to identify outliers; this will help audits and education to be more focused to fend off a more significant problem that could develop down the road.
Why should you pay attention to CBRs and outlier analysis?
CBRs are sent to providers who fall outside of normative billing ranges. In some cases, the deviations may make sense but in others, it is a good indicator that there is over or under-coding happening which could become problematic. While the current materials relating to CBRs indicate these are only educational materials, our industry knowledge tells us that these may be an early indicator that more audits are coming, which may result in take-backs and penalties. We have also heard that CBRs may be used to identify providers for the CMS’s Targeted Probe and Educate (TPE) program.
Using a platform like MDaudit Enterprise to identify billing outliers is critical for many reasons:
- It allows you to benchmark your providers billing patterns both internally against other providers in your organization and externally against CMS or the broader MDaudit community. This allows you to truly identify the providers billing outside of normative ranges.
- You are able to look at a variety of billing codes, whereas CBRs only focus on one billing code at a time.
- MDaudit Enterprise can help pinpoint your ‘at-risk’ provider population for both over and under-coding.
- It is critical to find and correct issues before CMS spots them to avoid audits that can cost your organization significantly in penalties and take-backs.
MDaudit Enterprise Customers
MDaudit customers can download this guide to see how they can use MDaudit to create an analysis similar to the CBRs to monitor their clients or validate the data on a CBR they have received.
Learn More About MDaudit Enterprise
If you are interested in learning more about how MDaudit Enterprise can help streamline your audit workflow, support TPE or MAC audit requests, and make your own outlier analysis easy, request a demo today!
More Resources:
Comparative Billing Report Website https://cbr.cbrpepper.org/About-CBR
