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CMS Posts Interactive Part B Claims Data for 2014

June 22, 2016:

On May 5, 2016, the Centers for Medicare and Medicaid Services (CMS) posted the third annual release of its Physician and Other Supplier Utilization and Payment public use data. The agency describes the data as evidence of its commitment to promote a “vibrant health information economy.”

Data transparency is also seen as an essential part of Medicare’s move toward paying providers based on the quality of care they give patients. The more information providers can access, the higher quality of care they can provide.

The data made available summarizes information on Part B services and procedures that health care professionals provided to Medicare beneficiaries in 2014. This latest release includes data for more than 986,000 health care providers, about 36,000 more than in the 2013 release. These providers received about $91 billion in Medicare payments in 2014.

Researchers can arrange the data to compare physician specialties, individual physicians, location, and the types of services provided, as well as submitted charges and Medicare payment.

A new feature in the 2014 data is that it uses the Medicare standardized payment amount. This makes comparing payment rates for individual services more meaningful, as geographic differences in payment rates caused by local wage levels or input prices are removed.

For example, if users sort the data by the Part B service with the highest number of unique beneficiary/provider interactions, they will see that more than 90 million 15-minute office or outpatient visits by established patients (CPT® code 99213) were provided in 2014. The average submitted charge amount was $120.53, the average Medicare allowed amount was $72.18, and the average Medicare payment amount was $49.79. Finally, we see that the average Medicare standardized payment amount for this service was $51.20.

Users who sort the data by Medicare payment amount will discover that in 2014, the most highly reimbursed service was HCPCS Level II code A9543 (Therapeutic treatment with Yttrium y-90 ibritumomab tiuxetan). Each dose up to 40 millicuries had a standardized amount of $34,158.99. The treatment was billed for 37 times, with an average submitted charge of $64,953.13.

CMS also announced that it is going to make more timely extracts of Medicare claims data available to researchers using Limited Data Sets (LDS). In the past, researchers using LDS have had to settle for annual information extracts from Medicare. Now, however, they can ask for extracts quarterly.

The database can be accessed at https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Medicare-Provider-Charge-Data/Physician-and-Other-Supplier2014.html.

CPT® is a registered trademark of the American Medical Association.


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