Variations in Medicare Reimbursement in Radiation Oncology: An Analysis of the Medicare Provider Utilization and Payment Data Set
| Autor: | T. Lanni, Charles C. Vu, John M. Robertson |
|---|---|
| Rok vydání: | 2016 |
| Předmět: |
Male
Cancer Research medicine.medical_specialty Office Visits media_common.quotation_subject Medicare Certificate of need Centers for Medicare and Medicaid Services U.S Reimbursement Mechanisms 03 medical and health sciences 0302 clinical medicine Radiation oncology Humans Medicine Radiology Nuclear Medicine and imaging 030212 general & internal medicine Medicare reimbursement Rural practice Sex Distribution Technology Radiologic health care economics and organizations Reimbursement media_common Radiation business.industry Professional Practice Location Clinical Coding Payment United States Oncology 030220 oncology & carcinogenesis Family medicine Multivariate Analysis Workforce Radiation Oncology Female Data set (IBM mainframe) Rural Health Services business |
| Zdroj: | International Journal of Radiation Oncology*Biology*Physics. 94:1000-1005 |
| ISSN: | 0360-3016 |
| DOI: | 10.1016/j.ijrobp.2015.11.045 |
| Popis: | The purposes of this study were to summarize recently published data on Medicare reimbursement to individual radiation oncologists and to identify the causes of variation in Medicare reimbursement in radiation oncology.The Medicare Provider Utilization and Payment Data: Physician and Other Supplier Public Use File (POSPUF), which details nearly all services provided by radiation oncologists in 2012, was used for this study. The data were filtered and analyzed by physician and by billing code. Statistical analysis was performed to identify differences in reimbursements based on sex, rurality, billing of technical services, or location in a certificate of need (CON) state.There were 4135 radiation oncologists who received a total of $1,499,625,803 in payments from Medicare in 2012. Seventy-five percent of radiation oncologists were male. The median reimbursement was $146,453. The code with the highest total reimbursement was 77418 (radiation treatment delivery intensity modulated radiation therapy [IMRT]). The most commonly billed evaluation and management (E/M) code for new visits was 99205 (49%). The most commonly billed E/M code for established visits was 99213 (54%). Forty percent of providers billed none of their new office visits using 99205 (the highest E/M billing code), whereas 34% of providers billed all of their new office visits using 99205. For the 1510 radiation oncologists (37%) who billed technical services, median Medicare reimbursement was $606,008, compared with $93,921 for all other radiation oncologists (P.001). On multivariate analysis, technical services billing (P.001), male sex (P.001), and rural location (P=.007) were predictive of higher Medicare reimbursement.The billing of technical services, with their high capital and labor overhead requirements, limits any comparison in reimbursement between individual radiation oncologists or between radiation oncologists and other specialists. Male sex and rural practice location are independent predictors of higher total Medicare reimbursements. |
| Databáze: | OpenAIRE |
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