CMS starts process to help physical therapists self-identify errors

CMS recently mailed its first set of comparative billing reports (CBRs) to 5,000 physical therapists across the nation to help self-identify errors. CMS created the CBRs to help providers prevent improper billing and payment. The reports are supposed to be proactive statements, not punitive indicators of fraud, said SafeGuard Services LLC, the authorized CBR producer.

"Comparative billing reports show providers how they stack up against their peers in the state and nationally in billing for certain risk areas" Melanie Combs-Dyer, a health insurance specialist in the CMS Provider Compliance Group, told the Report on Medicare Compliance. The CBRs resemble CMS's Program for Evaluating Payment Patterns Error Report (PEPPER), which targets 11 risk areas for short-term acute-care hospitals.

The initial CBRs provide utilization patterns so physical therapists can see how their billing practices compare to other physical therapists, notes RMC. According to SafeGuard, the CBRs are based on national Medicare claims data.

All providers are eligible to receive CBR data except physicians and inpatient hospital services, Combs-Dyer told RMC. "That makes pretty much everyone else eligible, including hospital outpatient services, hospices, labs, ambulances, skilled nursing facilities, home health agencies and chiropractors," she said.

The second round CBRs will be released in the beginning of October, targeting chiropractic services, SafeGuard announced.

For more:
- read the Report on Medicare Compliance article
- read the CBR overview from SafeGuard Services