Medicare Part B Data
Medicare Physician Payment Data
In May 2015, CMS published physician-identifiable data about services provided to Medicare beneficiaries. The data include information about payment made to physicians, number of provided services, and billed codes. Anyone can search the data file to see the amounts paid to each FFS Medicare provider.
- How can I find out what payment and utilization data were released about me?
The data are posted on the CMS website in a couple of formats: tab delimite file format that requires statistical software for analysis, Excel spreadsheets split by provider last name, and summary tables with aggregated information b physician name or HCPCS code. Also, you can access your payment data using the CMS interactive data tool.
In addition to the CMS website, the data were published by the New York Times ProPublica, and Wall Street Journal. These news outlets developed easy-to-navigate tools, searchable by name, specialty, and location.
- What can I do when I encounter a discrepancy?
There is no review period before the data are released. Questions regarding data accuracy can be directed to MedicareProviderData@cms.hhs.gov
- Could this data misrepresent neurologists’ utilization and earnings?
Yes, the data may over-exaggerate earnings of individual physicians because the reported payments made to physicians in a non-facility setting (e.g. office setting) include both professional and technical components. The technical component may drive up the cost. For facility setting, the reported payments include the professional component only.
- What should I tell my patients if they have questions about my data?
Become familiar with your own data and consider if/how it may be interpreted. Know the limitations of the public use files. If the inquiries are common, you may want to develop a readily available handout about the data and its limitations.
- What are some common limitations of the data?
- Data are not representative of the entire practice population. The file includes data for Medicare FFS Part B beneficiaries only. Information for patients who are enrolled in any form of Medicare Advantage plan, Medicaid, other federal programs (e.g. Tricare), and patients with private health insurance or uninsured is not included. Also, demonstration programs that are paid outside of the Medicare claims submission process are not included (note: some CMS demonstration programs utilize the Medicare claims process and those are included in the data file).
- The information in the data file does not tell us anything about the quality of care. The data file only contains cost and utilization information therefore, it is impossible to determine whether the provided care was necessary or not.
- Medicare payments for a given code vary based on modifiers, geography and other services performed during the day/visit; therefore, it is difficult to compare providers.
- Data are not risk adjusted and thus does not account for differences in disease severity. Payments could be driven higher because providers were treating sicker patients who required more treatment or because their practice was focused more on Medicare patients; therefore, high payments do not necessary indicate improper billing or fraud.
- To ensure patient anonymity, the file does not include data for services that were performed on 10 or fewer beneficiaries; therefore, summing the data in the file underestimates the true Part B FFS totals.
- With these limitations, should we use this data file at all?
Despite its known limitations, billing data are often used for research. The data in the public use file comes from the Physician/Supplier Part B Standard Analytical File (SAF). The public use file includes data for providers that had a valid NPI and submitted Medicare Part B non-institutional claims (excluding DME) during the 2012 and 2013 calendar years. Provider specialty was derived from the provide specialty code reported on the CMS 1500 claim form. This public file is a good source of information about payment made to physicians and services provided by physicians.
- What information was released about neurologists?
Data analysis revealed aggregated information on utilization of services neurologists' billing patterns, and costs to Medicare for services provided by neurologists to beneficiaries enrolled in Medicare FFS Part B in 2013.
- Overall, the 2013 public use file has information on 956,293 providers who were paid $89 billion
- Number of neurologists in the data file: 13,079
- Overall, Medicare FFS Part B paid neurologists over $1.3 billion.
- What’s the history behind the data release?
In 1979, the AMA was granted an injunction barring any release of doctor-specific Medicare information and the physician-identifiable data became inaccessible to the public. The injunction ended in 2013, but the data did not become public immediately. On April 9, 2014, CMS has released the first physician-identifiable public data file to the pubic citing the broad interest in viewing it. The second file with information containing information on utilization and payment made to providers under Medicare FFS Part B in 2013 was released on June 1, 2015.