CMS Releases Data on Medicare Payments to Providers, Including Clinical Labs

By Kelly A. Briganti, Editorial Director, G2 Intelligence

For a third year in a row, the Centers for Medicare & Medicaid Services (CMS) has released updated data regarding Medicare payments with its Physician and Other Supplier Utilization and Payment Public Use Data. The data includes Medicare charges from and payments to clinical laboratories. Labs and other providers can use this data to compare their charges to others in the market. The data can also reveal potential compliance issues as well.

CMS’ answers to questions about the data encourage reporting any suspected fraud revealed by the database contents. In answer to the question “What do I do if I think I’ve identified fraud in the Physician and Other Supplier PUF?” CMS encourages anyone suspecting “a potential case of Medicare fraud or abuse to visit http://stopmedicarefraud.gov/ for information on how to report it.”

The database also provides filters and visual graphic features to search and organize the available data. Categories of information include National Provider Identifier, provider name, provider credentials, entity type/gender of provider, provider address, provider type (i.e., clinical laboratory), place of service, HCPCS code and description, number of services provided, number of Medicare beneficiaries receiving the service, number of beneficiaries per day of service (which removes double counting of beneficiaries receiving multiple services), average Medicare allowable amount, average submitted charge, average Medicare payment amount, and average Medicare standardized amount.

In response to concerns about provider’s privacy, CMS explained in a letter to the American Medical Association that “the public’s interest outweighs the privacy interests. The Department concluded that the data to be released would assist the public’s understanding of Medicare fraud, waste, and abuse, as well as shed light on payments to physicians for services furnished to Medicare beneficiaries, which are governed by statutory requirements that CMS must follow.”