Historic Data Release Reveals Most Lucrative Billing and Coding Fields

The Centers for Medicare and Medicaid Services (CMS) recently released its Medicare Part B payment data for 2012. This shows how much doctors billed the program for medical services provided to their patients, and consequently, the most lucrative areas for medical billing and coding professionals. Specifically, the data contains the names of the physicians or health care providers and the charges submitted by medical billing professionals. This data has not been available to the public since 1979, and has revealed that in the year’s period over 880,000 health care providers received approximately $77 billion from CMS for Medicare Part B services. Part B covers outpatient services including physician visits, nursing care, dialysis, chemotherapy, transfusions, and the like. Excluded from this release is information about health care providers whose Part B patients numbered 10 or fewer.

The release of the data was not without controversy, with organizations like the American Medical Association (AMA) voicing strong opposition.

The Department of Health and Human Services (HHS), which oversees CMS, issued a press release detailing why it decided to release the data. It cited the goals of transparency in the health care system and making health care more affordable. This latter objective is advanced with the release because patients and industry experts can now more easily identify cases of waste or fraud, while at the same time analysts can make projections based on these statistics. This follows the release almost a year ago of data on hospital charges.

Immediately following the release, the AMA – the largest organization of physicians in the country and longtime opponent of the release – advised its members to look up their own names within the data to be aware of what may have been revealed about them. It also advised them to understand the data limitations in order to be able to explain this to concerned patients or the media. Finally, the AMA assured physicians it would sort through the data and provide key talking points aimed at clearing up any public confusion resulting from the release. Although not inherently opposed to the release of this data, the president of the AMA stated it would have liked to work with the CMS to release the data in a way that would not cause public misconceptions.

The data release has already revealed interesting statistics which would be of interest to professionals working in the medical billing and coding industry:

  • 75 percent of Part B health care providers received a median of around $30,000 and less than $85,000
  • Two percent of individual providers accounted for around $19 billion of the total $77 billion, or 23 percent of the total payments
  • Ophthalmologists proved to be among the specialists with the highest reimbursement rate, with 3,300 ophthalmologists nationwide being reimbursed $3.3 billion
  • The program payed out nearly $1 billion to cover the administration of a single drug to treat macular degeneration
  • The highest-reimbursed individual physician was an ophthalmologist, who was paid $20.8 million
  • 344 physicians across the country each were reimbursed more than $3 million

Those in the medical billing and coding profession can draw certain conclusions from this data release. First, certain locations receive a much higher percentage of Part B payments, such as Florida and California. These roughly mirror the locations with a higher percentage of those over 65 years old. Second, specialists tend to be reimbursed by Part B at a higher rate then general practitioners. And third, certain specialists such as ophthalmologists tend to receive a higher rate of reimbursement than other specialists.