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CMS Releases Medicare Billing Data

October 11th, 2016

The Centers for Medicare and Medicaid Services recently published some updated and fascinating information on Medicare billing to physicians and hospitals in the United States.

This data is being published in an effort to make the healthcare system more transparent, affordable, and accountable. The analysis shows, among other things, that anesthesiologists, orthopedic surgeons, ophthalmologists and emergency medicine physicians are among the most highly paid specialists.

It also provides information on Medicare Part D prescription drugs. There were over 1 million healthcare providers who prescribed about $103 billion in prescription drugs. Nexium was the most expensive drug prescribed, followed by Advair Diskus, Crestor, Abilify, Cymbalta, and Spiriva. The most common drug prescribed was Lisinopril, followed by Simvastatin, Levothyroxine Sodium, Hydrocodone-Acetaminophen, and Amlodipine Besylate.

The report also includes information on the 100 most common inpatient stays, involving $62 billion in Medicare payments and over 7 million discharges.

There is also data on 30 selected outpatient procedures performed at over 3,000 U.S. hospitals. Data included 950,000 physicians, nurse practitioners, and other providers which included about $90 billion in Medicare reimbursement. There were 3,900 providers who were paid at least $1 million dollars. A couple of the top ranked physicians are basing legal battles as several have been indicted on Medicare fraud charges.

The average physician was reimbursed about $74,000. The top 10 DRGs by payout included major joint replacement, septicemia, heart failure and shock, pneumonia, COPD, renal failure, esophagitis, and kidney and urinary tract infections. Providers received more money for mental health, sports medicine, and sleep medicine.

The most current data is for the year 2013. Data on hospital inpatient and outpatient charges first came out in the summer of that year. While this is the third annual report on the release of data for Medicare hospital utilization, it is only the second release of data on physician and other supplier and payment information.

You can read all the data here.

For information on the CMS prescriber level Medicare prescriptions data and a list of medications prescribed and costs, go here.