MEDICAL ECONOMICS
Medicare data go public What you need to know
BY CATHERINE I. HANSON, JD In a historic reversal of policy, on April 9, 2014, the Centers for Medicare & Medicaid Services (CMS) released extensive information about the payments it made to physicians and other providers of Part B Medicare ser- vices. The public release includes every person or organization that billed for those services in 2012 — more than 880,000 providers. The information is posted for download on the CMS website,
www.cms.gov, in a section titled “Medicare Provider Utilization and Payment Data.”
In addition to biller demographic data, it includes the fol- lowing data fields for 100 percent of the calendar year 2012 final-action, physician/supplier Part B noninstitutional line items for the Medicare fee-for- service population:
• Medicare participation (yes/ no);
• Place of service (facility/outpa- tient);
• HCPCS (CPT) code and HCPCS description;
• Line service, unique beneficiary, and distinct beneficiary per- day service counts;
• Average Medicare allowed amount and standard deviation Medicare allowed amount;
• Average submitted charge amount and standard devia- tion average submitted charge amount; and
• Average Medicare paid amount and standard deviation Medicare paid amount.
For those who don’t want to wade through these enormous
spreadsheets, The Wall Street Journal posted an easier-to-nav- igate — but less complete — database at
http://projects.wsj .com/medicarebilling. This includes physician or other provider name, address, specialty, and total Medicare payment amount. A drill-down screen shows the number of each procedure billed by CPT/HCPCS code, the average Medicare payment amount for each service, and the total paid for each service type in
2012. (To protect beneficiary identity, only services involving at least 11 beneficiaries are included.)
You owe it to
yourself to know where you stand and take charge of your profile.
How hard is it to figure out what I was paid? It takes only a few seconds to look up any physician or other Part B Medicare provider and find out what the government is reporting Medicare paid and for what services. It is also easy to see how the top physicians or other health care profes- sionals in the aggregate — or in particular specialties — rank by total Medicare payments. And it is equally easy to do this search by state or city. Your patients, your competitors, the managed care plans you contract with, your former or current employees, your friends, your enemies, the press, indeed anyone and everyone is now privy to your Medicare billing practices. Even worse, this is just raw claims data. With no way to put these data in context, the potential for viewers to misunderstand the raw data is significant.
What should I do? Most important, review your data! This is not the time to put your head in the sand. The “transpar- ency” genie is not going back in the bottle — ever. And, of course, where Medicare goes, private pay- ers usually are not far behind.
The first step is to look at your numbers and confirm wheth-
er they are correct. Historically, there have often been major data errors in databases of this type. If CMS has it wrong, you should get the information corrected as soon as possible. Start by contacting the medical director of your Medicare carrier.
What do I do if I’m not listed? Assuming you treated Medicare patients in 2012, the two most common reasons you won’t be listed are because your services were billed under a group national provider identifier (NPI) and taxpayer identification number (TIN) or because all your
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