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June 3, 2013

Medicare unveils charge data for 30 outpatient procedures

Daily Briefing

    Updated at 1 p.m.

    For the first time ever, CMS has released hospital-specific Medicare charge data for 30 outpatient procedures, less than one month after the agency released similar data on the 100 most-common inpatient procedures.

    The data—which were released on Monday—include a hospital's average charge for a given procedure, as well as the average Medicare payments that the hospital actually received for the procedure, including the Ambulatory Payment Classification amount, the Part B coinsurance amount, and the beneficiary deductible amount. 

    The data cover charges and payments from calendar year 2011. The 30 procedures in the dataset include clinic visits, echocardiograms, and endoscopies.

    Data show wide variation in hospital billing

    As with the inpatient data released in May, the new dataset reveals wide variation in the amount that hospitals charge patients for the same procedures, according to Kaiser Health News' "Capsules."

    For example, one hospital in Stockton, Calif., billed an average of $7,566 for a "level 3 diagnostic and screening ultrasound," while a facility in Hamilton, N.Y., billed just $157 for the same service.

    Moreover, the average amounts that hospitals charged for outpatient services were significantly higher than the amounts that Medicare paid out.

    For instance, hospitals billed an average of $148 for a "level 2 hospital clinic visit," but the program paid only $76 for the service. Similarly, hospitals charged $2,587 for "magnetic resonance imaging and magnetic resonance angiography without dye," but Medicare paid just $346 (CMS release, 6/3; CMS fact sheet, 6/2; Rau, "Capsules," Kaiser Health News, 6/3).

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