In April this year, Medicare finally made public records of payments it has made to doctors, making it possible for patients and interested parties to know how health-care providers charge the federal health insurance program for their services.
Following the physicians' Medicare billing data becoming a public record, ProPublica, an independent, nonprofit newsroom, looked at the billing records of doctors who had seen Medicare patients in 2012. In that year, 4 percent of all office visits were charged at the highest rate. Medicare paid doctors more than $12 billion for all patient visits in 2012.
The longest visits are often the most expensive and doctors can charge the highest rate for visits that last no less than 40 minutes. How much a doctor charges for a routine visit would also depend on the type of tests and treatments done and the severity of the patient's health problem.
By analyzing the records of 329,500 physicians and other providers, ProPublica found that while most health-care providers seldom have level 5 cases or "99215" appointments, which involve more time, more intense examinations and higher service charges, over 1,200 doctors billed Medicare for the highest level of visit 100 percent of the time and 600 did this 90 percent of the time. Level 5 visits could fetch taxpayers' money around $100 and this is several times more costly than the simplest office visits that would only cost around $14.
"We found that while most providers had a tiny percentage of level 5 cases, more than 1,200 billed exclusively at the highest level," ProPublica reported. "About 20,000 health professionals billed only at levels 4 or 5."
Some doctors are notably charging Medicare for the highest rate most of the time, regardless that most of their peers seldom charge for the level 5 cases. Hematologist-oncologist Louis VanderMolen from Orange County, Calif., for instance, billed almost 79 percent of his office visits for the highest level of appointment despite that his peers only do this for 12 percent of their office visits.
Of the top 30 doctors identified by ProPublica for charging for level 5 visits, the top two health-care providers were specializing in hematology/oncology, followed by three cardiologists. The rest of the doctors on the list that charge Medicare the most for office visits specialize in pulmonary disease, ophthalmology, internal medicine, emergency medicine, hematology, nephrology and infectious disease.
The top 10 states where doctors charge for level 5, or 99215 services, were California, Florida, Texas, New York, Illinois, Pennsylvania, Michigan, North Carolina and New Jersey.
