Studies from Beaumont Health System Further Understanding of Medicare and Medicaid (y Variations in Medicare Reimbursement in Radiation Oncology: An…

Studies from Beaumont Health System Further Understanding of Medicare and Medicaid (y Variations in Medicare Reimbursement in Radiation Oncology: An Analysis of the Medicare Provider Utilization and Payment Data Set)

By a News Reporter-Staff News Editor at Insurance Weekly News -- Investigators discuss new findings in Medicare and Medicaid. According to news reporting out of Royal Oak, Michigan, by VerticalNews editors, research stated, "The purposes of this study were to summarize recently published data on Medicare reimbursement to individual radiation oncologists and to identify the causes of variation in Medicare reimbursement in radiation oncology. The Medicare Provider Utilization and Payment Data: Physician and Other Supplier Public Use File (POSPUF), which details nearly all services provided by radiation oncologists in 2012, was used for this study."

Our news journalists obtained a quote from the research from Beaumont Health System, "The data were filtered and analyzed by physician and by billing code. Statistical analysis was performed to identify differences in reimbursements based on sex, rurality, billing of technical services, or location in a certificate of need (CON) state. There were 4135 radiation oncologists who received a total of $1,499,625,803 in payments from Medicare in 2012. Seventy-five percent of radiation oncologists were male. The median reimbursement was $146,453. The code with the highest total reimbursement was 77418 (radiation treatment delivery intensity modulated radiation therapy [IMRT]). The most commonly billed evaluation and management (E/M) code for new visits was 99205 (49%). The most commonly billed E/M code for established visits was 99213 (54%). Forty percent of providers billed none of their new office visits using 99205 (the highest E/M billing code), whereas 34% of providers billed all of their new office visits using 99205. For the 1510 radiation oncologists (37%) who billed technical services, median Medicare reimbursement was $606,008, compared with $93,921 for all other radiation oncologists (P <.001). On multivariate analysis, technical services billing (P <.001), male sex (P <.001), and rural location (P=.007) were predictive of higher Medicare reimbursement. The billing of technical services, with their high capital and labor overhead requirements, limits any comparison in reimbursement between individual radiation oncologists or between radiation oncologists and other specialists."

According to the news editors, the research concluded: "Male sex and rural practice location are independent predictors of higher total Medicare reimbursements."

For more information on this research see: y Variations in Medicare Reimbursement in Radiation Oncology: An Analysis of the Medicare Provider Utilization and Payment Data Set. International Journal of Radiation Oncology Biology Physics, 2016;94(5):1000-1005. International Journal of Radiation Oncology Biology Physics can be contacted at: Elsevier Science Inc, 360 Park Ave South, New York, NY 10010-1710, USA.

Our news journalists report that additional information may be obtained by contacting C.C. Vu, Beaumont Hlth Syst, Dept. of Radiat Oncol, Royal Oak, MI, United States. Additional authors for this research include T.B. Lanni and J.M. Robertson.

Keywords for this news article include: Michigan, Oncology, Royal Oak, United States, Health Policy, Medicare and Medicaid, North and Central America

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