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Medicare Outpatient Rate Argus Procedure Finalized 2018 PubMed articles on BioPortfolio. Our PubMed references draw on over 21 million records from the medical literature. Here you can see the latest Medicare Outpatient Rate Argus Procedure Finalized 2018 articles that have been published worldwide.
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Pancreatic pseudocyst endoscopic drainage by pancreatogastrostomy "pigtail" drain placement is spreading worldwide, with high success-rate and low morbidity, and is increasingly performed as outpatient procedure. The paper reports an unusual very early complication of this procedure and discusses the peculiar aspects of this event in an outpatient setting.
Medicare is moving toward value-based payment. The Merit-Based Incentive Payment System (MIPS) program judges outpatient clinicians' performance on a measure of annual Medicare spending. However, this measure may disadvantage outpatient clinicians who care for vulnerable populations because the algorithm omits meaningful determinants of cost.
The Centers for Medicare & Medicaid Services (CMS) introduced functional limitation reporting (FLR) to capture patient progress in functional status in outpatient rehabilitation settings. FLR along with the severity modifier (SM) measure the effectiveness of the rehabilitation services at the physical therapist evaluation (initial examination [IE]) after 10 days of therapy and at discharge.
To determine if there was a change in the number of outpatient physical therapy (PT) and occupational therapy (OT) visits for Medicare beneficiaries, and in the number of beneficiaries receiving extended courses of >12 therapy visits, after the "Jimmo v. Sebelius" settlement.
Understanding trends in reimbursement is critical to the financial sustainability of orthopedic practices. Little research has examined physician fee trends over time for orthopedic procedures. This study evaluated trends in Medicare reimbursements for orthopedic surgical procedures. The Medicare Physician Fee Schedule was examined for Current Procedural Terminology code values for the most common orthopedic and nonorthopedic procedures between 2000 and 2016. Prices were adjusted for inflation to 2016-dolla...
Observation stays are increasingly common, yet no standard method to identify observation stays in Medicare claims is available, including events with status change. To determine the claims patterns of Medicare observation stays, define comprehensive claims-based methodology for future Medicare observation research and data reporting, and identify policy implications of such definition, we identified potential observation events in a 2014 20% random sample of Medicare beneficiaries with both Part A and B cl...
To compare Medicare spending on provider-administered chemotherapy in hospital outpatient departments (HOPDs) and physician offices after controlling for cancer type.
Medicare Advantage (MA) enrollment has grown significantly since 2009, despite legislation that reduced what Medicare pays these plans to provide care to enrollees. MA payments, on average, now approach parity with costs in traditional Medicare.
There are large variations in the use of minimally invasive surgery (MIS), and outpatient hysterectomy (OP) among Medicare patients according to hospital surgical volume and geographical distribution.
To compare the prices paid to physicians by employer-sponsored Medicare Advantage (MA) plans with those paid by traditional Medicare (TM) and to determine whether the relationship between MA and TM prices is affected by the generosity of MA benchmarks.
Outpatient arthroplasty programs are becoming well established. Adverse event rates have been demonstrated to be no worse than inpatient arthroplasty in the literature for selected patients. The purpose of this study was to determine our rate of outpatient total knee arthroplasty (TKA), examine justification for exclusions, and estimate the proportion of TKAs that can occur safely on an outpatient basis.
High-quality screening mammography has been shown to substantially reduce mortality from breast cancer. Recall rate is a principal performance metric for screening mammography because it directly relates to the rate of false-positive examinations. This study aims to compare the recall rate derived using two sources-the claims-based Hospital Compare (HC) dataset from the Centers for Medicare & Medicaid Services versus the National Mammography Database (NMD) from the American College of Radiology-to understan...
To assess the retinal anatomy and array position in the Argus II Retinal Prosthesis recipients.
Preventive visit rates are low among older adults in the United States. We evaluated changes in preventive visit utilization with Medicare's introduction of Annual Wellness Visits (AWVs) in 2011. We further assessed how coverage expansion differentially affected older adults who were previously underutilizing the service. The study included Medicare beneficiaries aged 65 to 85 from a mixed-payer multispecialty outpatient healthcare organization in northern California between 2007 and 2016. Data from the ele...
Patients with advanced respiratory illness are often hospitalized, requiring close follow up after discharge and also requiring care coordination outside of traditional face-to-face outpatient visits. Primary Care providers and specialists often provide services outside of outpatient visits that have not been captured and reimbursed with traditional billing evaluation and management codes (E/M). Within the last five years, the Centers for Medicare and Medicaid (CMS) added new codes to the Medicare Physician...
Robotic extravesical ureteral reimplantation has been established as a viable option for surgical management of vesicoureteral reflux. Typically, this procedure is associated with a hospital stay for routine postoperative care. The aim of the study was to assess the short-term safety of robotic unilateral extravesical ureteral reimplantation as a scheduled outpatient procedure in a pediatric population.
The passage of the Veterans Access, Choice, and Accountability Act of 2014 has expanded the non-Veteran Affairs (VA) care options for eligible US Veterans. In order for these new arrangements to provide the best care possible for Veterans, it is important to understand the relationship between VA and non-VA care options. The purpose of this study was to use another recent VA policy change, one that increased the reimbursement rate that eligible Veterans receive for travel for health care to VA, to understan...
The observed sex gap in physician salary has been the topic of much recent debate in the United States, but it has not been well-described among orthopaedic surgeons. The objective of this study was to evaluate for sex differences in Medicare claim volume and reimbursement among orthopaedic surgeons.
The administrative costs of providing health insurance in the US are very high, but their determinants are poorly understood. We advance the nascent literature in this field by developing new measures of billing complexity for physician care across insurers and over time, and by estimating them using a large sample of detailed insurance "remittance data" for the period 2013-15. We found dramatic variation across different types of insurance. Fee-for-service Medicaid is the most challenging type of insurer t...
Low-vision assistive devices are not covered by Medicare and many private insurers, although there is evidence that they can improve functioning and quality of life. Little is known about whether sociodemographic disparities exist in the use of low-vision services by Medicare beneficiaries.
The primary objective of this study was to describe surgical treatment patterns among women with newly diagnosed uterine fibroids (UF). A secondary objective was to estimate the medical costs associated with other common surgical interventions for UF. Claims-based commercial and Medicare data (2011-2016) were used to identify women aged ≥30 years with continuous enrollment for at least 12 months before and after a new diagnosis of UF. Receipt of a surgical or radiologic procedure (hysterectomy, myomectomy...
To better understand health habits in older nurses versus the general population, we sought to determine whether the demographics, health care utilization, and Medicare spending by the Nurses' Health Study (NHS) participants enrolled in Medicare and a matched sample of Medicare beneficiaries meaningfully differed.
This paper examines, theoretically and empirically, how changes in the demand for health insurance and medical services in the non-Medicare population - coverage eligibility changes for parents and the firm size composition of employment - spill over and affect health insurance coverage and how these factors affect per beneficiary Medicare spending. We find that factors that increase coverage and hence demand for medical services in the non-Medicare population generate contemporaneous decreases in per benef...
In the traditional Medicare program, the use of health care services-particularly postacute care-varies substantially across geographic regions. Less is known about such variations in Medicare Advantage (MA), which is growing rapidly. Insurers that are paid on a risk basis, as in MA, may have incentives and tools to restrain the use of services, which could attenuate geographic variations. In this study of fifty-four million Medicare beneficiaries in the period 2007-13, we found that geographic variations i...