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Medicare News
Medicare Posts Payments to Physicians, Hospitals for
Common Treatments as Consumer Guide
November 21, 2006 The Centers for Medicare &
Medicaid Services has made another step forward in providing consumers
with information on the cost of healthcare services, which is aimed at
helping them make better healthcare decisions. The latest data online is
the payment information for physician and hospital outpatient services.
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The release yesterday includes data for common
services provided in physicians offices, as well as services performed
in a hospital outpatient department. This information complements the
inpatient hospital and ambulatory surgery center data already posted to
the CMS website.
The information includes payment rates for over 70
physician services rendered in non-office settings as well as 19
services usually performed in a physicians office. The outpatient
hospital payment data being released also will give information for
commonly performed procedures.
President Bush has directed that more data be made
available to all Americans as part of the administrations commitment to
make health care more affordable and accessible, according to CMS. This
directive was stated in a Presidential Executive Order, on August 22,
2006.
Yesterdays announcement is the third set of
information allowing consumers to review payment data for different
areas of the country. The data is by state and major markets.
As a first step in this initiative, on June 1
Medicare posted the costs it pays hospitals for 30 common elective
procedures and other hospital admissions. On August 21, CMS added
charge and payment information for common procedures performed in
ambulatory surgery centers (ASCs).
The latest CMS is posting payment information for
common physicians' services, including anesthesia services, as well as
services performed in a hospital outpatient department. Coupled with the
inpatient hospital and ASC data already posted, this latest information
will provide consumers with more comprehensive information about
services performed in various provider settings.
The four physician files are as follows:
"Physician Payments: 72 Commonly Performed
Services in a Non-Office Facility Setting" is two files which contain
service volumes, charge, and Medicare payment data for physicians'
services for a limited set of services, including anesthesia services,
rendered in Medicare payment localities. These particular codes/services
are directly related to the types of services which may be rendered in
an inpatient hospital, outpatient hospital, or ASC, and correlate to
most of the procedure codes already posted.
"Physician Payments: 19 Other Commonly Performed
Services Provided in an Office Setting" contains similar service,
charge, and Medicare payment data, but for physicians' services of high
utilization which are commonly performed in a physician's office.
The fourth physician file contains a 1-page example
of the comprehensive physician data.
Finally, the PDF document contains two simple
examples/scenarios of how the transparency data may be used by a
consumer.
Note Regarding Current Procedural Terminology (CPT)
Codes Used in the Tables: CPT only copyright 2006 American Medical
Association. All rights reserved. Applicable Federal Acquisition
Regulations System (FARS)/Defense Federal Acquisition Regulation
Supplement (DFARS) Apply. CPT is a registered trademark of the American
Medical Association.
The new information posted by CMS at
www.cms.hhs.gov/HealthCareConInit/ will allow consumers and users of
the data to compare the costs and procedures, which may vary depending
upon the site of service, and to select the most appropriate setting for
the delivery of high quality, efficient care.
The new information on physicians and hospital
outpatient departments adds to the information that people can use to
make better decisions on their care, said CMS Acting Administrator
Leslie Norwalk, In all areas of care -- hospitals, physicians, nursing
homes, health plans, and prescription drugs -- we are supporting
collaborative efforts that are providing unprecedented information to
help people get the best quality care for the best price.
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Sample
of Physician Information
Following
information on physician service charges is for the nation
but in the system on the Medicare site it is listed for each
state and many major cities. |
|
Breast biopsy through skin
with sampling device |
|
CPT
19103 |
|
Allowed Services+ |
Avg Sub Charge+ |
Avg Allow Chrg+ |
Avg Payment+ |
|
79,494 |
819 |
286 |
226 |
|
Field Descriptions
● Allowed Services: A count
of the number of services performed for a procedure.
● Avg Sub Charge: Submitted
charges divided by allowed services.
● Avg Allow Chrg: Average
Medicare allowed charge divided by allowed services. This
includes deductibles and coinsurance amounts for which the
beneficiary is responsible.
● Avg Payment: Average
Medicare payment divided by allowed services. This does not
include deductibles and coinsurance amounts for which the
beneficiary is responsible.
● Localities: Geographic
areas designated for payment purposes. Medicare payment
rates for physicians' services are adjusted in each locality
by a geographic adjustment factor which reflects the
relative costs of resources involved with furnishing such
services in a locality compared to the national average of
such costs. |
>>
For more consumer healthcare cost comparisons click here
Downloads Available
●
Physician Payments: 72 Commonly Performed Services in a Non-Office
Facility Setting Across all Specialties [Excel Zipped, 79KB]
●
Physician Payments: 72 Commonly Performed Services in a Non-Office
Facility Setting Across all Specialties - Continued [Excel Zipped, 88KB]
●
Physician Payments: 19 Other Commonly Performed Services Provided in an
Office Setting [Excel Zipped, 46KB]
●
Physician Payments Example [Excel Zipped, 10MB]
●
Transparency Initiative Scenarios [PDF, 16KB]
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