Monitoring provider coding and billing risks is a constantly evolving challenge.  One great tool to monitor high risk provider billing in your organization is the Comparative Billing Report (CBR).  CBRs are generated by Medicare Administrative Contractors and summarize Medicare claims data statistics for individual providers.  CBRs are released only to the individual providers they provide data for and present results of statistical analyses that compare an individual provider’s billing practices for a specific billing code or policy group with the practices of that provider’s peer groups and the national averages. Each CBR is unique to its recipient, and each provider sees only his/her own billing data. No data attributable to any specific provider is made publicly available.

While healthcare organizations do not have access to specific providers’ reports or data, CBR topics and national- and state-level data are available online.  Healthcare organizations can combine these datasets with their providers’ Medicare claims data to monitor for potentially high outlier providers within its network.  Dean Dorton has developed an interactive report which breaks down the topics and benchmarks for select CBR topics from recent years.

Dean Dorton Healthcare

Lance Mann, CPA, CFE, CGMA
Assurance Director • 502.566.1005

Adam Shewmaker, FHFMA
Healthcare Consulting Director • 502.566.1054