Comparative Billing Reports - What is this New CMS Tool?
The Centers for Medicare and Medicaid Services (CMS), which protects the Medicare Trust Fund from improper payments, is now using Comparative Billing Reports to educate providers. Comparative Billing Reports reveal utilization patterns and provide comparative data on how one individual health care provider varies from other providers within their state and across the nation. CMS then communicates these findings to the providers by written correspondence. Essentially, the Comparative Billing Report (CBR) is used to show that a health care provider’s billing patters are excessive or otherwise outside the norm.
CMS believes that Comparative Billing Reports will give health care providers an opportunity to correct any deficiencies in their billing habits and increase compliance with billing, coding and documentation guidelines. Although the CBR is not intended to show fraudulent behavior, CMS believes that the CBR is a useful tool to give providers a chance to be proactive in their compliance efforts. CMS has contracted with two companies to produce and disseminate these CBRs. Safeguard Services, LLC is responsible for producing the Comparative Billing Report. Livanta, LLC is responsible for disseminating the Comparative Billing Report.
CMS expects that the CBR will accurately reflect a provider’s performance versus his or her peers. CMS also expects the provider to use the information to identify opportunities for improvement. While CMS claims that the information is simply a tool to assist the provider, a Comparative Billing Report should not be ignored. If a provider receives a CBR, he or she should contact a health law attorney or coding expert so that the information can be reviewed and used to improve the provider’s reporting practices and help the provider avoid a Medicare post payment review.
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The Martin Law Firm is a health law firm located in Blue Bell, Montgomery County, PA. The Martin Law Firm represents health care providers for matters involving health care compliance, Medicare audits and appeals, insurance post-payment reviews and general business matters. Contact The Martin Law Firm to speak to an experienced health care attorney today.