Department of Health and Human Services to Release Medicare System Data


Last week, the Department of Health and Human Services (HHS) announced that they will begin to publicly release Medicare system data, including payment and utilization rates, for the 880,000 physicians currently participating in the Medicare program. This development will bring significant changes to the Medicare community, as newer payment policies direct providers to be compensated based on their quality of care, rather than the quantity of services they provide. In addition, accessibility to this data will provide the opportunity for analyses on services and procedures provided to patients, as well as payments received by individual health care providers.

Beginning April 9, the Centers for Medicare and Medicaid Services (CMS) released data, including procedures, payment/charge data, and site of service for physicians and other health care providers by National Provider Identifier (NPI). For each NPI/Healthcare Common Procedure Coding System (HCPCS) combination, the additional data includes the number of services, the average charge and standard deviation in charge, the average payment and standard deviation in payment as well as the number of unique patients treated. Steps will be taken to protect patient-identifiable information in cases where data represents fewer than 11 patients.

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DISCLAIMER: Because of the generality of this update, the information provided herein may not be applicable in all situations and should not be acted upon without specific legal advice based on particular situations.

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