Billing – how do your claims compare to other allergists?

CMS issued Comparative Billing Reports (CBR) for individual allergy and immunology providers in late July. The reports are based on Medicare Part B claims and reflect a provider’s billing patterns as compared to their peers for the same services in their state or specialty and nationwide. Only allergists with billing patterns significantly higher than either their peer group or national averages will receive a CBR.

Look for an email from cbrpepper.noreply@religroupinc.com or go to the CBR portal to access your report. If you’re unsure whether you have a CBR, submit a request to the CBR help desk.

Update your email address in PECOS to ensure you receive the report. CBRs should not be confused with reports produced by Medicare Administrative Contractors (MAC).

CBRs are issued to help protect the Medicare Trust Fund and to increase providers’ awareness about the utilization of allergy/immunology services. A CBR report is not an indication of, or precursor to, an audit, and it requires no response on a provider’s part. Selected providers, however, may be referred for additional review and education as a part of CMS’ routine CBR Program. CBRs are issued because of differences in your billing practices compared to other allergists/immunologists in your state and/or nationally.

The data summarizes statistics for dates of service from Jan. 1, 2019 through Dec. 31, 2019.
CBRs analyze the following:

Percent of all claim lines that were allergen injections (CPT 95115 – 95117).
Percent of allergy services that were antigen preparation (CPT 95144 – 95199).
Percent of allergen injections submitted with an evaluation and management (E&M) service (CPT 99201 – 99205 and 99211 – 99215).

A man with hands on hips looking at chalk drawings of question marks and bags of money

CMS data suggests allergy/immunology has a 1.9% improper payment rate.

63.5% is attributed to insufficient documentation.
36.5% is attributed to incorrect coding.

Each allergist/immunologist’s value is compared to allergists/immunologists across the nation. Four possible outcomes include:

Significantly Higher – Provider’s value is greater than or equal to the 90th percentile or national mean.
Higher – Provider’s value is greater than the allergy group or national mean.
Does Not Exceed – Provider’s value is less than or equal to the allergy group or national mean.
Not Applicable (NA) – Provider does not have sufficient data for comparison.

If you receive a CBR, don’t panic. Review the report and your coding practices to ensure they are in compliance with Medicare guidelines.

CBR Resources: