Last week, CMS released a report summarizing the Medicare billing data for physicians across the country. Doctors panicked and patients attempted to understand what all these steep numbers meant, meanwhile buzz terms like “healthcare price transparency” and “reimbursement rates” flew around with more aggressive velocity than ever before.

For those that are unsure what this billing report really means, we’ve given you a breakdown. Read on to learn everything you need to know about this release.

 

1.     The report shows which physician specialists are getting paid the most and approximately how much they are receiving from CMS.

2.     So what are these payments supposed to cover? Medicare fees are supposed to cover the physician’s actual work, overhead costs for their equipment, malpractice insurance and other costs. What are those “other” costs though?

3.     It shows amounts paid but doesn’t delineate where specialties with high overhead costs come into play. For example, Radiation Oncologists incur significant overhead costs to provide their specialized services, so they get reimbursed much more to cover those costs.

Information provided by The Wall Street Journal. Source: Centers for Medicare and Medicaid Services

Information provided by The Wall Street Journal. Source: Centers for Medicare and Medicaid Services

4.     There are tons of dollar amounts being shown, but the figures do not correlate to patient levels or success rates, so the impact of the costs cannot be easily determined.

5.     The report was supposed to help catch Medicare fraud activity, but it doesn’t do this very effectively. This is because it lumps a lot of physicians into groups regardless of outside factors like overhead costs.

6.     The goal of displaying this data was that exposure would change overall behavior.

7.     The database does not break out payments by PC and TC. Rather, they are aggregated, explaining why the numbers seen in the Wall Street Journal article are so steep.

8.     Separate from the aggregated data, there is also a larger dataset of information which is HUGE and includes the following information for each physician in the country:

·         Average charge/CPT code

·         Number submitted/CPT code

·         Average amount per procedure code

·         Billing addresses of physicians

·         Procedure performed in a “facility” or “non-facility”

·         POS codes for procedures

9.     This dataset file is too big for Excel, but if you link the text file to Access you can use it.   We learned via the RBMA chatter, that some have had success this way, saying, “Once I got a query result I used Excel to manipulate and analyze the data.” Keep this in mind if you’re looking for a way to sort the data yourself.

10. This big number: $121 million. As in, the sum of what the top 10 physician billers charged for Medicare in 2012.


Important links for learning more:

Dataset:

http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Medicare-Provider-Charge-Data/Physician-and-Other-Supplier.html

WSJ Article:

http://online.wsj.com/news/article_email/SB10001424052702303873604579492012568434456-lMyQjAxMTA0MDEwMTExNDEyWj

WonkBlog Summary of Physician Responses:

http://www.washingtonpost.com/blogs/wonkblog/wp/2014/04/10/wonkbook-why-doctors-are-upset-about-the-medicare-payment-data-release/

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