Download and open Part_B_National_Summary.accB in Microsoft Access 2010. This is

Question

Download and open Part_B_National_Summary.accB in Microsoft Access 2010. This is a database generated from spreadsheets for 2009 and 2010 downloaded from http://www.healthdata.gov. The Medicare Part B national datasets are summarized by meaningful Healthcare Common Procedure Coding/Current Procedural Terminology (HCPC/CPT) code ranges. Each data set displays the allowed services, allowed charges, and payment amounts by HCPCS/CPT codes and prominent modifiers. In addition, there is a README file (PartBNationalSummaryReadmeFile2010.pdf) available in this unit that provides additional information about the datasets. Using SQL statements, answer the following questions:

1.       What was the difference between Payment and Allowed Charges for HCPCS codes associated with ‘INTEGUMENTARY’ in 2009?

Just need code/query

https://uwli.courses.wisconsin.edu/content/himt/400/su17/sec02/summer/Data-handling%20projects/1-2/PartBNationalSummaryReadmeFile2010.pdf?_&d2lSessionVal=sIdqpUc37fkkjoEbIHSRb12Pp&ou=3822612

Explanation / Answer

Information for Users
The information in Part B National Summary Data Files is limited to Medicare Fee-ForService
(FFS) Part B Physician/Supplier data. It does not include information on
physician/supplier services for beneficiaries in the managed care portion of the program
(Medicare Advantage).
HCPCS Coding Systems
The HCPCS is divided into two principal subsystems, referred to as Level I and Level II
of the HCPCS.
Level I of the HCPCS is comprised of CPT-4, a numeric coding system maintained by
the AMA. The CPT-4 is a uniform coding system consisting of descriptive terms and
identifying codes that are used primarily to identify medical services and procedures
furnished by physicians and other health care professionals. These health care
professionals use the CPT-4 to identify services and procedures for which they bill
public or private health insurance programs. Level I of the HCPCS, the CPT-4 codes,
does not include codes needed to separately report medical items or services that are
regularly billed by suppliers other than physicians.
Level II of the HCPCS is a standardized coding system that is used primarily to identify
products, supplies, and services not included in the CPT-4 codes, such as ambulance
services and Durable Medical Equipment, Prosthetics, Orthotics, and Supplies
(DMEPOS) when used outside a physician's office.
About the Datasets
The data sets are summarized by meaningful HCPCS/CPT code ranges. Brief
descriptions for the code ranges and modifiers are provided in the readme file (see
Numeric and Alpha numeric Code Ranges and Descriptions sections below). The data
set name contains the year followed by a five character sequence that is the
HCPCS/CPT code. This HCPCS/CPT code corresponds to the first HCPCS/CPT in the
selected code range of disciplines. Within each code range are, procedural, condition,
or description subheadings. Each data set displays the allowed services, allowed
charges, and payment amounts by HCPCS/CPT codes and prominent modifiers. A
sample data set is shown below:
Code Ranges 00100 – 01999
HCPCS MODIFIER DESCRIPTION ALLOWED SERVICES ALLOWED CHARGES PAYMENT
00100 AA ANESTHESIA 5,580 $1,187,161 $935,402
AD 168 $13,287 $9,996
QK 5,102 $620,723 $489,280
QZ 2,347 $415,336 $327,821
OTHER 5,944 $654,184 $518,378
TOTAL 19,141 $2,890,692 $2,280,878
Modifiers are defined below in the readme file. These reports only illustrate the
modifiers when more than one bill can be submitted for one procedure. The surgeon,
ASC, and assistant at surgery can all bill separately using the same HCPCS/CPT.
Utilization for modifiers not affected by duplicative counting is collapsed into the other
category on the reports. Therefore, not all CMS published modifiers are illustrated.
In example one below, surgery code 66984 (cataract surgery w/iol), the primary
surgeries are shown in the modifier field labeled “other”. The allowed services billed by
the assistant at surgery (modifier 80’s) were three and the ASC facility (modifier SG)
billed a total of 934,343 allowed services. Averages should be calculated by dividing
the total allowed charges or total payments by the “other” service counts, which
represent the actual number of procedures. Averages may also be calculated by
individual modifiers. The ASC and assistants reimbursement would be substantially
lower than that of the surgeon.
Total allowed charges / Other allowed services = Average Allowed Charge
$2,020,413,040 / 2,108,557 = $958
Total payment / Other allowed services = Average payment
$1,603,276,188 / 2,108,557 = $760

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