Hi Rick
I'm very skeptical of the analysis. I don't know of anyplace where physician reimbursement at 180% of Medicare is the norm for physicians...it certainly isn't nationwide. Some places, commercial reimbursement is below Medicare.
I just skimmed through it, but my best guess is that somehow they have included a significant number of hospital claims in the mix. If you factored in hospital claims and compared to the Medicare physician fee schedule, then 180% might be plausible, especially if you're looking at aggregate spending where TC would be more heavily weighted than PC. I do believe the Fair Health database includes hospital claims, and I can't remember whether it's possible to split them out.
I'm sure some of our billing company friends could provide a more accurate analysis.
Dave
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David Smith FACMPE
Executive Director
United Imaging Consultants
Mission KS
(785) 393-8387
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Original Message:
Sent: 10-21-2021 13:53
From: Rick Sylvanus
Subject: Radiology paid 180% of Medicare from commercial carriers?
A study published by The Urban Institute claims that various specialties are paid amounts significantly higher than Medicare. It's an interesting read:
Commercial Health Insurance Markups over Medicare Prices for Physician Services Vary Widely by SpecialtyUrban Institute | remove preview |
| Commercial Health Insurance Markups over Medicare Prices for Physician Services Vary Widely by Specialty | Private insurers generally pay physicians substantially higher rates than Medicare does for the same service. Policy proposals to reduce commercial prices and curb health care spending by benchmarking private payment rates to Medicare prices could therefore significantly affect physician payments, but the effects will likely vary considerably by specialty. | View this on Urban Institute > |
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Anyone else find these numbers surprising?
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Rick Sylvanus
Operations Manager
Southern Delaware Imaging Associates
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