Not a Lexis Advance subscriber? Try it out for free.

Health Care

Barnes & Thornburg: CMS Releases Physician-Level Payment Data Totaling More Than $90 Billion in Medicare Reimbursements for 2013

By Jessica Talati

On June 1, the Centers for Medicare & Medicaid Services (CMS) released its second annual installment of Medicare reimbursement data for physicians and other practitioners. The data set contains records for more than 950,000 practitioners who received a collective $90 billion in Medicare payments during 2013 calendar year. The physician data consists of information on the number and type of healthcare services furnished by practitioners under Medicare Part B’s fee-for-service (FFS) program.  Consumers, providers and other stakeholders can review the data by individual provider (using the provider’s National Provider Identifier (NPI)) as well as by the specific furnished service (grouped by Healthcare Common Procedure Coding System (HCPCS) codes).  The following types of information, among others, is provided for each provider and service: 

  • Total number of services furnished
  • Provider’s average charge
  • Average Medicare payment
  • Average Medicare-allowed amount 

The 2013 data also provides more comprehensive summary files than years past, including one by individual NPI; and, for the first time, it includes separate totals for medical services and drug services. CMS’s first physician data release of 2012 reimbursements drew some ire from physicians and other practitioners who called the release of total Medicare payment data only misleading since some specialties rely significantly on expensive drug therapies.  The 2013 physician reimbursement data is available on CMS’s Medicare Provider Utilization and Payment Data website. 

Monday’s release also included a third annual installment of inpatient and outpatient hospital utilization and payment data for 2013 calendar year, which can be found here and here

In a statement, CMS touted the release of the data as an important step forward in providing access to and expanding the public’s understanding of Medicare program spending, stating “[d]ata transparency facilitates a vibrant health data ecosystem, promotes innovation, and leads to better informed and more engaged health care consumers.”  CMS intends to continue releasing hospital and physician data on an annual basis.

Jessica Talati

Ms. Jessica Talati is an associate in Barnes & Thornburg’s Chicago office and a member of the Healthcare Department. Ms. Talati advises clients on a variety of healthcare regulatory and compliance matters with a particular emphasis on fraud and abuse issues. She has experience representing healthcare providers and pharmaceutical companies in all aspects of internal investigations and civil and criminal enforcement actions, including OIG self-referrals, subpoena compliance and grand jury proceedings.

For more information about LexisNexis products and solutions, connect with us through our corporate site