Medicare to send Comparative Billing Reports to primary care clinicians to facilitate accurate billing

This June, CMS will be sending a Comparative Billing Report (CBR) to a select group of 5,000 primary care clinicians, focusing on evaluation and management (E/M) codes for office visits.

The CBR is a tool used by CMS to enhance coding accuracy and is not intended to be punitive or an indication of suspected fraud. The reports are being sent as part of CMS's effort to facilitate accurate billing. A recent study indicated that 8.4% of E/M services were being billed at the wrong code level—either too high or too low. The CBR is a confidential, educational tool to assist physicians and other health care professionals in a self-audit of their individual coding practices through a comparison to aggregated coding data from a related reference group.

The College provides a similar educational tool to its members. This tool compares a practice's overall coding pattern against the Medicare national average and provides a hypothetical estimate of the dollar difference between the current coding pattern and the national average. It is available to ACP members on the Running a Practice section of the College's website.