Healthcare providers' 2014 Medicare reimbursements are now available to anyone with a computer. These massive online spreadsheets, posted last month by CMS, provide a wealth of data about providers' Medicare Part B services, charges, and reimbursements.  Individual and institutional providers are listed by name.

Users can sort and filter the data to find information such as the following:

  • A certain primary care physician billed Medicare an average of $175 each for 284 established patient office visits for an average payment of $70.44.
  • The Houston provider with the most Medicare reimbursements for HCPCS Code 36415 ("Insertion of needle into vein for collection of blood sample") during 2014 was Quest Diagnostics, which was reimbursed 328,225 times for an average payment of $2.94.
  • The highest average Medicare payments in the country—$36,706.13 per service—went to Cascade Hemophilia Consortium in Michigan.
  • The individual physician with the highest total Medicare reimbursements in Texas ($6.2 million) was a Tyler ophthalmologist.
  • A total of seven San Antonio female dermatologists were reimbursed by Medicare for performing ear biopsies in 2014, with average submitted charges ranging from $105 to $218.

Providers know that government watchdogs are examining their Medicare claims, but now the public also can manipulate the data to answer questions about providers or services in a given locality. "The public" includes, of course, competitors, journalists, litigants, and perhaps a hopeful whistleblower or two.

"Providers shouldn't lose sleep over the availability of this data," says Sam Louis, a former Deputy Criminal Chief of Program Fraud for the Department of Justice who now handles healthcare fraud litigation at Strasburger. "But they should be aware of the data's existence and know how their Medicare charges and payments compare with those of other providers in their geographic area."

While valid reasons often exist for certain providers' reimbursements being higher than most, these providers should know whether they are "outliers" in their category as outliers tend to receive the most scrutiny.

A link to the 2014 CMS data can be found below. For those interested in comparing reimbursements over time, data for 2012 and 2013 also is available on the website. In addition, CMS has posted spreadsheets dedicated to reimbursements for inpatient services, skilled nursing facilities, home health agencies, and medical devices.

Click here to view the CMS data.

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