Medicare Part B payments to local healthcare providers

How much does Medicare reimburse a doctor? That depends on many factors such as: the type of service, whether it’s simple or complex, even whether the doctor is billing only for the service or also is billing for the technology to perform the service.
For the first time since the 1970s, the Centers for Medicare & Medicaid Services has released information on the numbers of services doctors perform and how much they are reimbursed. The Medicare Fee-For-Service Provider Utilization & Payment Data Physician and Other Supplier Public Use File covers reimbursements to more than 880,000 providers across the country.
This database contains information on 3,844 physicians in the six-county Rochester region for services rendered in 2012. Before looking up what your doctor was reimbursed, keep in mind:
» The database covers only reimbursement under Part B. Medicare Advantage is not included.
» The data doesn’t say anything about quality of care or pass any judgment on whether or not the services were warranted.
» A doctor had to perform a service for at least 11 patients.
» Medicare reimbursements are fixed. Doctors do not negotiate.
Those are just some of limitations that CMS acknowledges. The agency has admitted the raw data can be confusing; late Friday it announced it was seeking proposals for interactive visual interpretations to make the numbers meaningful to consumers.
To help you understand what you’re seeing, here is a glossary of the column headings:
» HCPCS description: Description of the Healthcare Common Procedure Coding System code for the specific service provided.
» Avg Medicare allowed amt: Average of what Medicare allowed to be reimbursed. The figure is the sum of the amount Medicare pays + the patient deductible and coinsurance + any amount from a third party.
» Avg submitted charge amt: Average of the charges that the provider submitted to Medicare for the service.
» Avg Medicare payment amt: Average amount that Medicare paid minus the patient deductible and coinsurance.
Source: Centers for Medicare & Medicaid Services and staff research.
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