It’s all in the data: and it’s available.
A few years ago, I was giving a presentation to a group of cardiologists. I provided to them a schedule for all the members of the group indicating how much Medicare had paid them by procedure code for the prior year. I went on to tell them the names of the medical schools they had graduated from and the addresses and phone numbers of all their offices.
I showed them that they had been billing all evaluation and management (E&M) claims at the highest code level – and that exposed them to a risk of audit.
One of the physicians got very angry. He thought I had hacked their computers. He wanted to throw me out and call the authorities. I had to explain to him that all the data I presented came from public sources.
If you work for a hospital, nursing home, home health administration, hospice, federally qualified health center, renal dialysis facility, community mental health clinic, or rural health clinic, your financial operations, including census data, gross charges, Medicare charges, and Medicare reimbursement amounts, are also public data – dating back to 1996.
If you work for a hospital, the names and national provider numbers (NPIs) of all the physicians credentialled at your hospital is public data.
If you are a physician or other Part B provider, the amount of money you were paid by the pharmaceutical industry, including speaking fees and debt forgiveness, is public data.
For physicians, all of your office’s information, including addresses and phone numbers, is public data. The school you graduated from and when you graduated? Yes, that is all public data also.
If you work for a hospital or nursing home, someone can get a list of your Medicare paid claims (stripped of HIPPA identifiers) as public information.
It is important to understand that as a provider of healthcare in the United States, you are in one of the most regulated industries in the world. All providers in the United States should know what information is out there about them, and what data is available about their competitors.
Literature is ripe with classic phrases that seem timelessly apropos. For example, take the partial federal government shutdown. For days, the phrase repeated in the
Medicare, like many other insurers, often pays doctors a standardized rate based on the service they performed. Open heart surgery costs $X, a blood test
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