In response to members repeatly asking, "what should I be getting paid?"; Private Practice Section purchased over a million dates of service in claims data from Milliman actuarial firm in 2014, intending to provide better answers to this question. Further more, Milliman was engaged to analyze commercial insurance and Medicare data, developing a cost per unit benchmarks for physical therapy services. Data for E&M codes, chiropractic, radiology, and orthopedic services were also obtained for pricing comparison, and point of reference for bundled payment arrangements. PPS now has this data by state showing the average price "allowed" by the commercial insurance carriers with breakdowns by percentile and per member per month (PMPM) cost for the 97000 series of codes is also provided.
Given the massive amount of data, PPS will initiate sharing this data with members through a series of webinars, Impact articles and presentations at PPS Annual Conference. This webinar is the first in a series, revealing the pricing data and sharing identified trends. As the first webinar, focus will be the 97000 series of CPT codes. Subsequent webinars will discuss trends and benchmarks for the physician, radiology, chiropractic, and surgical codes. Finally, this webinar will provide recommendations and strategies for using the data when positioning your practice for payer negotiations, payer audits, and determining your charge master.
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