||CMS Sends Billing Outlier Reports to Part B Providers; Metrics Show How to Identify Them
For about a year, a new CMS contractor has been mining data nationally on certain billing outliers, including emergency department services and breast re-excision, and making it available to health care providers—although some of them may be unaware of this. The Comparative Billing Reports (CBRs) are similar to the Program for Evaluating Payment Patterns Electronic Report (PEPPER)—they have free, provider-specific data that can be used to monitor and improve compliance—but there are meaningful differences. A big one: CBRs are only sent to Part B providers who are outliers, and it’s up to them to figure out why. PEPPERs, in contrast, are sent to all hospitals and other Part A providers.
“We are looking at all Part B providers nationally,” says Kim Hrehor, program director of RELI Group Inc., in Catonsville, Maryland, which generates CBRs for CMS. “Providers have to know where these vulnerable areas are, and they have to understand if it’s something that impacts their operations.” There’s about one monthly release of CBRs, which are distributed through a portal on the CBR website (cbr.cbrpepper.org). To ensure providers know the data is available, RELI Group informs them by fax and email, Hrehor tells RMC. Continue Reading
|Report on Medicare Compliance