Emergency Department Services Comparative Billing Report (CBR)
Our CBR helped to drive down unnecessary spending and helped educate providers on proper coding.
Our program integrity mantra at CMS is “pay it right.” We use many levers to pay it right, including ones that educate and inform providers about how their billing practices compare with their peers.
Comparative Billing Reports (CBRs) compare an individual provider’s billing and/or prescribing practices for a specific billing code, policy group, or service with the billing and/or prescribing practices of that provider’s peers in the same state and/or specialty, and national averages.
On November 6, 2017, CMS sent CBRs to 7,245 providers with abnormal billing practices for Emergency Department Services (emergency room visits for the evaluation and management of a patient) (CPT® Codes 99281 – 99285). We chose these services for a CBR because the 2016 Medicare Fee-for-Service Improper Payments Report identified a 12.4% error rate in billing for emergency room visits, meaning that approximately $268 million, in improper, or incorrect, payments were made.
The result? In May 2019, CMS observed an 11% decline in CPT® Codes 99281-99285 and a 9% ($63.8 million) decline in allowed charges for these codes. Our CBR helped to drive down unnecessary spending and helped educate providers on proper coding.
For more information on CBRs visit the Comparative Billing Reports page.