April 3, 2008
Requesting a Comparative Billing Report—Part A Providers
Comparative billing report (CBR) information is available to providers by request. The purpose of the CBR is to show comparative data Medicare considers when determining how a provider’s billing patterns contrast with other providers in the same specialty. A CBR may be a helpful tool for providers when conducting self-audits.
Comparative Billing Reports by Type of Bill
Medicare compares a Part A provider to its peers by type of bill using quantity billed per beneficiary per procedure code. This type of CBR contains billing information for a provider in six-month intervals. Medicare updates the reports four times per year for the following dates of service:
• January through June
• April through September
• July through December
• October through March
Since Medicare bases a CBR on dates of service and not processed dates, Medicare must allow two to three months to permit claims to be finalized before a report can be generated. For example, the April through September timeframe is not available until December or January.
How to Request a Comparative Billing Report
To request a CBR, providers must follow these steps:
• A provider must request a CBR on office or corporate letterhead and the provider/officer signature must be affixed. A request from a corporate entity must be submitted by a corporate officer, or in the case of a hospital, the hospital administrator. If the requesting provider wants the information sent to another party, it must be noted in the letter.
• The mailing address must be stated clearly and legibly in the letter, since these reports will only be sent via the U.S. mail, and not electronically.
• The CBR request must include the Medicare provider number and the type of bill. (Due to the volume of data, Medicare cannot generate a report for types of bill 11X or 12X.)
• The request must be faxed to Statistical and Medical Data Analysis at 904-791-8006 or mailed to:
First Coast Service Options
Statistical and Medical Data Analysis
532 Riverside Avenue, 19T
Jacksonville, FL 32202
Statistical and Medical Data Analysis
532 Riverside Avenue, 19T
Jacksonville, FL 32202
There is no fee for providing these reports.
Once Medicare receives a CBR request, the report and a CBR explanation document will be mailed to the requesting provider (or authorized party) within ten business days.
Source: CMS Pub 100-08, Medicare Program Integrity Manual, Chapter 3, Section 11.1.6
