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HHS Releases Medicare Claims Data; Provider Org. 'Troubled'

April 9, 2014
by Gabriel Perna
| Reprints

The Department of Health and Human Services (HHS) has released data that reveals Medicare claims payments to providers this week, HHS Secretary Kathleen Sebelius announced.

The data is the third tier of payment information released by the government. Back in May of last year, the Centers for Medicare & Medicaid Services (CMS) publicly released hospital charge information from hospitals across the U.S. It later released more hospital charge information in June.

This latest data shows payment and submitted charges, claims data, for services and procedures provided to Medicare beneficiaries by physicians and other healthcare professionals. The data in this set covers calendar year 2012 and contains 100 percent final-action physician/supplier Part B non-institutional line items for the Medicare fee-for-service population. In particular, it has information for over 880,000 distinct healthcare providers who collectively received $77 billion in Medicare payments in 2012, under the Medicare Part B Fee-For-Service program.

“Currently, consumers have limited information about how physicians and other healthcare professionals practice medicine,” Secretary Sebelius said in a statement. “This data will help fill that gap by offering insight into the Medicare portion of a physician’s practice. The data released today afford researchers, policymakers and the public a new window into health care spending and physician practice patterns.”

The data will help consumers compare 6,000 different types of services and procedures provided, as well as payments received by individual healthcare providers. The consumers can also compare by physician, specialty, location, the types of medical service and procedures delivered, Medicare payment, and submitted charges.

Already, those providers are pushing back, calling the decision to release this data regrettable. “MGMA is troubled about the potential for unintended consequences as a result of the release of this type of data and the effect it may have on Medicare beneficiaries. This release could result in patients making decisions about their care based on faulty assumptions about physicians. Claims data are not a proxy for quality, especially when provided in isolation, from a single payer," Susan Turney, M.D., president and CEO of MGMA, said in a statement.

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