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Understanding the Centers for Medicare & Medicaid Services (CMS) Comparative Billing Reports

Five thousand pathologists across the country recently received a notification from eGlobalTech in July, 2014. The Comparative Billing Report (CBR) reflects your individual billing or referral patterns for immunohistochemistry and special stains services on gastric and combined gastric/colon biopsies provided to Medicare Part B beneficiaries in 2013.  CBRs have been developed and distributed under contract by eGlobalTech, a Federal services firm based in Arlington, VA. 

Each CBR contains statistical tables and an explanation of findings that compare providers' billing patterns to those of their peers in the state and across the nation for the related IHC and special stains Current Procedural Terminology (CPT) billing codes 88305, 88312, 88313, and 88342.   According to CMS, the intent of the CBRs is to provide education to the provider community on billing trends while allowing CMS to efficiently manage Medicare resources. While Part A/B MACs have been producing a limited number of CBRs to targeted providers for many years, CMS has now formalized and expanded the program to a national level.  

Per eGlobalTech, the study was based on a statistical debriefing developed to define the national and state averages derived from the analysis of national claims data for IHC and special stains on gastric and combined gastric/colon biopsies.   These usage averages were then compared with individual provider usages for related claims with 2013 dates of service.   The complete Statistical Debriefing can be found at the following link: http://www.cbrinfo.net/cbr201407-statistical-debriefing.html.

Only pathologists with two statistical deviations deemed ‘significant’ were sent CBR201407.  While APS encourages our pathologists receiving it to review the data for informational purposes, please keep in mind that the study’s methodology is based on national claims data for these codes and would not take into consideration individual elements of a provider/group that could legitimately lead to a higher usage of these services.  

As always APS maintains a rigorous schedule of auditing to ensure correct coding in keeping with the documented interpretive reports received from our providers.  If you have any questions regarding this, please contact your Practice Manager or Client Representative.

eGlobalTech directs any questions regarding this CBR to 1.800.771.4430 or cbrsupport@eglobaltech.com

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