ArticleClinical ophthalmology (Auckland, N.Z.)2024
Trends in Medicare Submitted Charges to Allowed Payment Ratios for Ophthalmology Services.
Article in Clinical ophthalmology (Auckland, N.Z.), 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Authors and funding
3 authors.
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Abstract
Purpose: Many physicians charge more than the Medicare insurance program pays. Current charge-to-payment ratios in ophthalmology and trends over the years are unknown. In this work, we examined physician charge-to-payment ratios in ophthalmology across procedures and consultations. Methods: We utilized data from 100% final-action physician/supplier Part B Medicare fee-for-service (FFS) population from 2015 to 2020. We retrieved data on ophthalmic procedures and consultations, both facility-based and non-facility-based, conducted by ≥ 50 ophthalmologists. We analyzed median charge-to-payment ratios, which were calculated as submitted charges divided by the Medicare-allowed payments, between ophthalmic procedures and consultations to assess for trends over the study period. Results: We find that the median charge-to-payment ratio for all current procedural terminology (CPT) codes in 2020 was 2.23 (Interquartile range (IQR): 1.54-3.27) as compared to 2.00 (IQR: 1.39-2.92) in 2015, an overall 2.76% average annual growth rate from 2015-2020. For ophthalmic procedures, the median charge-to-payment ratio in 2020 was 3.03 (IQR: 2.13-4.41) compared to 2.79 (IQR: 1.96-3.97) in 2015, corresponding to a 2.01% AAGR from 2015-2020. For consultations, those rates were 2.06 (IQR: 1.48-2.96), 1.85 (IQR: 1.33-2.59), and 2.71%, respectively. Conclusion: We found that the submitted charge-to-Medicare payment ratios among ophthalmic procedures and consultations have steadily increased since 2015. However, there was a relatively low rate of excess charges for ophthalmology services compared to other surgical-based specialties with minimal variation among providers.
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