Affiliation:
1. School of Medicine, Tufts University, Boston, Massachusetts, USA
2. Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
Abstract
The degree of markup between provider charges and Medicare prices reflects the potential balance bill for out-of-network commercially insured patients. Using publicly available Medicare data, we performed a retrospective cross-sectional analysis of markup ratios (MRs; ie, the ratio of submitted charges to Medicare-allowed prices) for services commonly performed by otolaryngologists in 2017. Median MRs were as follows: 2.9 (interquartile range, 2.0-4.3) in facility settings (eg, hospital) and 2.1 (interquartile range, 1.7-2.9) in nonfacility settings (eg, physician office). Among the 10 highest-markup procedures performed by otolaryngologists in facility and nonfacility settings, there was no consistent increase in median MRs between 2012 and 2017 (compound annual growth rates, –4.6% for labyrinthotomy to 24.6% for ultrasound-guided biopsy). Median MRs for these procedures were not consistently lower in states with surprise billing protection laws. These findings may reflect the comparatively low potential to “balance bill” patients for elective otolaryngologic services and the limitations of state-level protections against surprise billing.
Subject
Otorhinolaryngology,Surgery
Reference14 articles.
1. The Commercial Differential for Hospital Prices
2. Medicare program; hospital inpatient prospective payment systems for acute care hospitals and the long-term care hospital prospective payment system and final policy changes and fiscal year 2021 rates; quality reporting and medicare and medicaid promoting interoperability programs requirements for eligible hospitals and critical access hospitals. Federal Register. Published September 18, 2020. https://www.federalregister.gov/d/2020-19637
3. Out-Of-Network Billing And Negotiated Payments For Hospital-Based Physicians
4. “Surprise” Out-of-Network Medical Bills
Cited by
10 articles.
订阅此论文施引文献
订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献