Trends in Medicare Submitted Charges to Allowed Payment Ratios for Ophthalmology Services.
Clin Ophthalmol
; 18: 859-863, 2024.
Article
en En
| MEDLINE
| ID: mdl-38525383
ABSTRACT
Purpose:
Many physicians charge more than the Medicare insurance program pays. Current charge-to-payment ratios in ophthalmology and trends over the years are unknown. In this work, we examined physician charge-to-payment ratios in ophthalmology across procedures and consultations.Methods:
We utilized data from 100% final-action physician/supplier Part B Medicare fee-for-service (FFS) population from 2015 to 2020. We retrieved data on ophthalmic procedures and consultations, both facility-based and non-facility-based, conducted by ≥ 50 ophthalmologists. We analyzed median charge-to-payment ratios, which were calculated as submitted charges divided by the Medicare-allowed payments, between ophthalmic procedures and consultations to assess for trends over the study period.Results:
We find that the median charge-to-payment ratio for all current procedural terminology (CPT) codes in 2020 was 2.23 (Interquartile range (IQR) 1.54-3.27) as compared to 2.00 (IQR 1.39-2.92) in 2015, an overall 2.76% average annual growth rate from 2015-2020. For ophthalmic procedures, the median charge-to-payment ratio in 2020 was 3.03 (IQR 2.13-4.41) compared to 2.79 (IQR 1.96-3.97) in 2015, corresponding to a 2.01% AAGR from 2015-2020. For consultations, those rates were 2.06 (IQR 1.48-2.96), 1.85 (IQR 1.33-2.59), and 2.71%, respectively.Conclusion:
We found that the submitted charge-to-Medicare payment ratios among ophthalmic procedures and consultations have steadily increased since 2015. However, there was a relatively low rate of excess charges for ophthalmology services compared to other surgical-based specialties with minimal variation among providers.
Texto completo:
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Base de datos:
MEDLINE
Idioma:
En
Revista:
Clin Ophthalmol
Año:
2024
Tipo del documento:
Article
País de afiliación:
Estados Unidos