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Medicare posts data on providers who referred medical equipement

The data represent over 100 million claims and $11 billion in Medicare allowed payments.

Susan Morse, Senior Editor

The Centers for Medicare and Medicaid Services on Thursday posted data on physicians and providers who referred medical equipment and supplies.

Over 385,000 providers referred products such as wheelchairs, walkers and diabetes supplies in 2013, according to CMS. The data represent over 100 million claims and $11 billion in Medicare allowed payments.

The claims data is broken down in numerous ways.

By specialty, internal medicine and family practice providers are the largest referring specialties, with 87,107 and 81,603 referring providers respectively. They have average allowed amounts of $29,954 for internal medicine and $27,982 for family practice.

Pulmonary disease has 8,513 referring providers, but has the largest allowed amount of $156,021, due to the high number of oxygen and nebulizer supplies they prescribe.

Durable medical equipment claims accounted for 80 percent of all claims and 62 percent of the total Medicare allowed amount for services.

Claims for prosthetic and orthotic devices, drugs and nutritional products accounted for a disproportionate share of the total allowed amount for services, according to CMS. Prosthetics and and orthotic devices accounted for 10 percent of claims but 20 percent of the total allowed amount; and drugs and nutritional products accounted for 9 percent of claims and 18 percent of the allowed amount.

The data set  is published as The Referring Provider Durable Medical Equipment, Prosthetics, Orthotics and Supplies Public Use File.

Its aim is transparency, affordability and accountability, according to CMS.

"CMS is providing this data to support insight and innovations in healthcare delivery," said Acting CMS Administrator Andrew Slavitt.

It contains information on utilization, payment and submitted charges organized by National Provider Identifier, Healthcare Common Procedure Coding System code and supplier rental indicator.

It was created from CMS administrative claims data for Medicare beneficiaries enrolled in the fee-for-service program available from the CMS Chronic Condition Data Warehouse.

Twitter: @SusanJMorse

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