Physician Payment Transparency

Overview

Physician organizations have long had concerns with releasing Medicare billing information. Since 1979, courts have prevented CMS from publishing the information, yet CMS has given partial data sets to researchers. In June 2013, a federal judge lifted the injunction and in January 2014, CMS modified the administration’s policy on physician payment disclosure and announced that it would evaluate requests for physician payment information.

As a result, CMS received numerous requests for Medicare physician payment information and determined that, in accordance with the Freedom of Information Act (FOIA), it must make frequently requested materials available electronically. Thus, CMS decided to publicly release certain physician payment information on its website.

The AAFP recognizes the potential value of Medicare physician claims data. If used correctly, it can potentially provide accurate and meaningful information to patients, physicians, and other stakeholders that could improve quality at the point of care. 

On April 9, 2014, the Centers for Medicare & Medicaid Services (CMS) announced the availability of the Medicare Provider Utilization and Payment Data: Physician and Other Supplier Public Use File. This data set covers over 880,000 distinct health care providers who collectively received $77 billion in Medicare payments in 2012 from the Medicare Part B Fee-for-Service program.

On June 1, 2015, CMS posted the annual release of the Medicare hospital utilization and payment data (both inpatient and outpatient) and the second annual release of the physician and other supplier utilization and payment data. The Medicare hospital utilization and payment data consists of information for 2013 about the average amount a hospital bills for services that may be provided in an inpatient stay or outpatient visit. The Medicare Part B physician, practitioner, and other supplier utilization and payment data shows payment and submitted charges, or bills, for those services and procedures by provider. It allows for comparisons by physician, specialty, location, types of medical services and procedures delivered, Medicare payment, and submitted charges. The new 2013 dataset has information for over 950,000 distinct health care providers who collectively received $90 billion in Medicare payments. 


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