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Making Medicare Compliance Easier for You

in Medicare

CBRs at the Speed of Technology

By: Rhonda Hodge, MCS-P

Oh, how we’ve longed to hear that a process has been made easier! In this fast paced and ever-changing world, it is certainly music to our ears, especially when it comes to areas such as Insurance, Medicare and Compliance.

Our profession has certainly seen many various changes over the years. One of those is the use of electronic methods for everything from billing, verification of benefits, claim appeals, pre-authorizations and the patient’s health records, just to mention a few. It seems that everyone is jumping on the “e(electronic)” bandwagon.

For those that are not technologically in the know, the indication of “e” before a word, indicates it has use in an electronic format. For example: e-mail, e-commerce, e-business, e-banking, e-sports, e-paper, e-cigarette, e-car, and e-book.

Recently, insurance carriers have been utilizing this technology, by means of electronic portals, to assist their beneficiaries and providers with the gathering or reviewing of data. Now, Medicare and some Medicare Administrative Contractors (MAC)s are doing the same. They are even using this electronic method to make it easier for providers to access information such as claim status, medical review policies and the newest addition, the Comparative Billing Report (CBR).

What is a CBR?

A CBR is a report generated to provide data regarding billing patterns, code utilization and service comparisons to other providers in your area. This information helps providers perform self-audits. Not only is self-auditing valuable to your office, but it is also a key element in a mandatory Compliance Program as set forth by the Office of Inspector General (OIG).

The ability to gather information to aid in conducting a self-audit is extremely beneficial; and the ease of being able to now gather it online, versus submitting a request for the report, is not only a time saver, but is also far more accurate. Previously, by the time the CBR was received by mail, the information was more than likely inaccurate. Another added benefit to this process is that it ensures both adherence to Medicare guidelines and that compliant claims are being submitted, potentially avoiding a pre or post payment review.

CBRs can include a variety of statistical information from your Evaluation & Management codes for New Patient and Established Patient exams, Chiropractic Services, billing patterns, documentation, coding and much more. These reports are generated by a company that is contracted with the Centers for Medicare & Medicaid Services (CMS) called eGlobalTech. This Federal company located in Arlington, Virginia makes this information available to providers to help them review, address and correct any areas in which compliance is not being met.

In years past, the CBR was made available to individual health care providers and contained both state and national payment patterns with graphs that reflected areas where improper payments frequently occurred. While this originally was generated only in areas across the region where specific billing issues were seen, it has now been broadened to a national level. Medicare has also established a CBR Help Desk for providers. Following the release of each CBR, eGlobalTech (eGT) provides a teleconference or webinar for provider education about the CBR and allows providers the opportunity to ask questions.

The Importance of a Compliance Program

As stated earlier, it is mandatory that all healthcare facilities have an effective Compliance Program in place. This is mandated by Health & Human Services (HHS) and enforced by the Office of Inspector General (OIG). Contrary to popular belief, this was established to assist providers in self-monitoring and auditing to discover, document and correct any improper and non-compliant incidents, prior to being audited. This process helps to establish that intention to defraud was not present.

A CBR or any other resource that aids in this process should be highly utilized. The fact that this has been made easier by the eCBR shows that entities such as CMS want to assist providers in being compliant. CMS uses many different entities and tools to protect the Medicare Trust Fund, but whenever possible, they are transparent and assist providers in being compliant. The CBR is just one of those tools.

If your office has not yet established an effective Compliance Program, don’t hesitate - start today. The information gathered through the eCBR can help. Below are a few links to the MACs to access either the CBR or eCBR.

Rhonda Hodge began her career in Chiropractic in 2000. She became an Account Manager in the office where she had been a patient. Rhonda has extensive experience with the regulations, training, and guidelines associated with the Occupational Safety and Health Administration (OSHA). She is also very well-versed in Safety and Loss Prevention and is currently focused on Compliance. Rhonda became a Medical Compliance Specialist – Physician (MCS-P) in 2012—the year she joined KMC University and where she has helped clients complete Medicare Enrollments for their patients and written curriculum and training webinars. Rhonda has extensive experience with finances, front desk operations, training, billing and collections, Medicare, and compliance.

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