About CBR Page

What is a CBR?

Comparative Billing Reports (CBRs) summarize Medicare claims data statistics in support of the Centers for Medicare & Medicaid Services’ (CMS) efforts to protect the Medicare Trust Fund. CBRs are disseminated to the provider community to provide insight into billing trends across regions and policy groups, and they present analyses of billing practices across geographic and service areas.

In general, a CBR presents 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.

History of CBRs

Medicare Administrative Contractors (MACs) produce comparative billing reports for providers in their jurisdiction to educate their providers about vulnerable areas in the Medicare program. CMS has formalized and expanded the CBR program at the national level. The CBR is just one tool that CMS employs in its ongoing efforts to protect the integrity of the Medicare Trust Fund. Other activities include:

  • Educating providers about Medicare’s coverage, coding and billing rules/payment policy;
  • Reviewing claims before they are paid to assure compliance with Medicare payment policy/coverage, coding and billing rules (called prepayment review); and
  • Reviewing claims after they are paid (called post-payment review) to identify and collect overpayments made to providers.

CMS employs A/B MACs and Durable Medical Equipment (DME) MACs to enroll providers and suppliers into the Medicare program, process and pay claims, educate providers, conduct prepayment and post-payment reviews, and perform other tasks in accordance with the specific contract. CMS employs Recovery Audit Contractors (RACs) to perform post-payment review.

CMS also learns of Medicare program vulnerabilities through reports issued by the Department of Health and Human Services (HHS) Office of the Inspector General (OIG), the Government Accountability Office (GAO) and data analysis conducted by CMS employees and CMS contractors (such as the Comprehensive Error Rate Testing Program).

Mission for CBRs

RELI Group’s mission is to support CMS’ efforts to protect the Medicare Trust Fund through the development, production and distribution of reports summarizing Medicare claims data and to support providers as they obtain and utilize these reports.