Health Information Management

News: CMS data shines light on Medicare payment process

CDI Strategies, June 11, 2015

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If you’ve ever wondered how Medicare reimburses hospitals and pays physicians, new data from CMS may help clear the fog. 

On June 1, the agency released data on how much hospitals billed and received for both inpatient and outpatient services in 2013, as well as how much Medicare paid physicians. CMS looked at what different hospitals nationwide charge for similar services, and what Medicare paid those hospitals for 100 of the most common inpatient stays by more than 3,000 hospitals reimbursed under IPPS.

Some of the top DRGs were heart failure and shock with CC; simple pneumonia and pleurisy with CC; and renal failure with CC. The data also included the 30 most common outpatient procedures.

The inpatient data covers seven million discharges for which Medicare paid $62 million. The physician data is based on 950,000 physicians and other providers for which Medicare paid $90 billion.

CMS began releasing such information in the summer of 2013, for billing and reimbursement data for 2011 and 2012. Last spring, the CMS released the physician data for 2011 and 2012. As in previous years, the most recent data showed a variation in what hospitals charge and what Medicare pays. For information, view the full CMS report.  

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