Medicare Provider Essay

1026 words - 5 pages

Hello All, This is what we decided needs to be done:
Anne - Xiaotian – Doing Regression analysis across the 1 million sample set
* Compute Regression coefficients of
* Medicare Paid amount v/s Medicare charged amount and Medicare allowed amount , lines of service , For the following services At Regional Level

Northeast |   | | |   |   |
Row Labels | Average of AvgPaid | | | Row Labels | Average of AvgPaid |
36415 | 28.98% | | | 36415 | 31.10% |
97110 | 50.95% | | | 97110 | 45.27% |
97140 | 47.68% | | | 97140 | 41.91% |
99213 | 47.08% | | | 99213 | 46.00% |
99214 | 47.35% | | | 99214 | 46.07% |
Grand Total | 45.46% | | | Grand Total | 43.75% ...view middle of the document...

For Cardiology – Jay
* Distribution Curve of Average Paid Amount per Provider – Mean / Max / SD
* Box Plot
8. Hemant
1. What are the five most expensive procedures in each region of the US? – Hemant
a. Who are the physicians that most frequently perform these procedures and what is the average claim amount? – Hemant
b. How frequently do these physicians perform these procedures? – Hemant
c. What is the average costs and how variable is it across the country (separated into regions)? – Alejandro
d. What is the difference between amount allowed and amount charged? In which states are costs the highest? – Alejandro
9. Popular Services in Each Region and Average Amount Paid by Medicare – Hemant
10. Do Physicians over bill – Alejandro

For which services do providers overbill the most (at the region level) - where is the difference between charged amount and allowed amount (BILLED/ALLOWED)? Difference between charged amount and allowed amount is the highest.
Medicare paid amount should be less or equal to allowed amount. (Medicare Side). - ALEJANDRO

Here is a proposal based on Hypothesis Testing and Difference of Means:

Based on Top Five Procedures

Null Hypothesis:
Charged amounts for services > Medicare paid amount
Difference of means for charged and paid > 0

Alternative Hypothesis:
Doctors charge what they will be paid Difference of means is = (close to) 0

11. Regression Analysis of Popular Services BY Region – Anne
* Predictability based on Regression

12. Questions

Emails -
Actually, Question 3 in the last email Jay and Xiaotian, the two of you can work on that.

Evan, can you look to answer this one (it was one of our original questions from the proposal):

1. What are the five most expensive procedures in each region of the US?
a. Who are the physicians that most frequently perform these procedures and what is the average claim amount?
b. How frequently do these physicians perform these procedures?
c. What is the average costs and how variable is it across the country (separated into regions)?
d. What is the difference between amount allowed and amount charged? In which states are costs the highest?


On Sat, Apr 11, 2015 at 2:37 PM, Alejandro Villacís...

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