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Comparative Billing Reports

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April 14, 2016

Comparative Billing Reports (CBRs) are administered by the Centers for Medicare & Medicaid Services (CMS). These reports contain information about specific CPT code usage, and are sent to individual providers to alert them to potential over-utilization of these codes in the Medicare Fee-For-Service (FFS) program. Each report shows the provider how he/she compares to peers in the same specialty locally and nationally, and is intended to give providers an opportunity to seek additional training and to review Medicare guidelines to ensure compliance.


Announcement of new CBRs are made public, but individual comparative billing reports with physician-specific data will only be sent to providers that have been identified by CMS as at-risk.


At Fi-Med, we make this information available to our hospital and health network clients, who then use that data to run “what if” queries on their providers using our predictive analytic compliance dashboard, REVEAL/md. This allows our clients to stay ahead of government and commercial payer audits by identifying areas targeted by CMS prior to receiving a CBR alert.


The following is a list of to-date CBRs for 2016. If you would like to receive notification each month of CBRs as they are released, please join our email list below.

April 2016

Modifiers 24 & 25: General Surgeons

This CBR is expected to focus on general surgeons who submitted claims for established patient evaluation and management services (E/M) appended with modifier 24 and/or modifier 25.

Subsequent Nursing Facility E/M Services

This CBR is expected to focus on Subsequent Nursing Facility Evaluation and Management Services and providers. The CBR will focus on providers of all specialties who bill Current Procedural Terminology (CPT) codes 99307-99310 to report subsequent nursing facility evaluation and management services. CPT codes for


Subsequent Nursing Facility E/M Services includes CPT codes 99307-99310.

March 2016

Non-invasive Vascular Studies

This CBR focuses on Non-invasive vascular studies, specifically duplex scans of the extracranial arteries, lower extremity arteries or extremity veins, billed by providers of all specialties except radiology. The analysis includes CPT code 93880, 93882, 93925, 93926, 93970 and 93971.

February 2016

Modifier 25: Internal Medicine

This CBR focuses on internal medicine physicians' use of modifier 25. CPT codes 99211, 99212, 99213, 99214, 99215 were included in this analysis.

Electrodiagnostic Testing (EDX)

This CBR focuses on Electrodiagnostic Testing (EDX) and CPT codes 95905, 95907 - 95913, 95860, 95861, 95863 - 95870, 95885 – 95887 are included in the analysis.

January 2016

Domiciliary Evaluation and Management Services

The focus of this CBR is Domiciliary Evaluation and Management Services and its purpose is to educate providers who bill CPT codes 99334 – 99337 and provide E/M services to patients in a shared living situation (i.e. group home or assisted living facility). 

 

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