Doubt Cast HCC Risk Score To Predict Payments - DoctorsManagement Doubt Cast HCC Risk Score To Predict Payments - DoctorsManagement

Doubt Cast HCC Risk Score To Predict Payments

By Frank Cohen, Director of Analytics and Business Intelligence

As originally published by Racmonitor.com

A couple of weeks ago, the Centers for Medicare & Medicaid Services (CMS) released the 2014 physician Medicare utilization data file. This is the third file released in as many years and contains a large portion of the utilization detail for 923,813 individual National Provider Identifier (NPI) codes, the majority of which are for physicians, NPs, and PAs.

In general, the file contains information on the procedures providers report to Medicare, along with the number of unique beneficiaries, the number and identification of services provided to those beneficiaries (for both drug and non-drug related services), and the payments made to those providers.  In total, this file accounts for $90,012,301,857.01 in payments and 2,617,809,025 procedures. And this does not represent all payments and all services for all Medicare beneficiaries, as this data only represents traditional Medicare services and not Medicare Advantage (because for some reason they are not required to provide data to the public sector). So even though our tax dollars are used to support Medicare Advantage plans, they are not subject to the same level of accountability as traditional Medicare.

So much for transparency.

Read the full article on Racmonitor.com