Comparative Billing Reports

Published 06/16/2022

Palmetto GBA uses CBRs as an educational tool for providers to use in order to provide insight into their billing patterns and utilization of services in comparison to their peers. A CBR will include links to additional education material and the associated Medicare guidelines. Providers can then use this information to conduct a self-audit to ensure they are in compliance with the Medicare regulations and prevent improper claims submission in order to avoid possible pre or post-pay medical review.

Last Reviewed: 6/16/2022

Comparative Billing Reports (CBRs) show providers how they rank against their peers nationally in billing for certain risk areas. CBRs do not contain patient specific data. The CBR applies to all provider types. The CBR is not intended to be punitive or sent as an indication of fraud: it is intended to be proactive statements that will help the provider identify potential errors in their billing practice.

If you receive a CBR:

  1. Evaluate your agency’s billing patterns to ensure the claims are billed accurately
  2. Examine the issue identified in the report to see if there are reasons your agency is an outlier in the data
  3. Evaluate the CPT/HCPCS/ICD-CM codes used related to the issue in the report to verify the most appropriate code is used

You may receive a call from a Palmetto GBA representative to discuss the three questions listed above and provide any other additional information you may have.

Last Reviewed: 06/16/2022