Scott Kaple D.O.

Gender: M
Medical School: Other
Graduation Year: 1988
Primary Specialty: Family Medicine

2017 Medicare Provider Charge and Payment Data

Medicare Participation?Y
Number of unique HCPCS codes submitted63
Total Provider Services2564
Total Medicare beneficiaries receiving the provider services459
The total charges that the provider submitted for all services$365,060.00
The Medicare allowed amount for all provider services. This figure is the sum of the amount Medicare pays, the deductible and coinsurance amounts that the beneficiary is responsible for paying, and any amounts that a third party is responsible for paying.$207,657.68
Total amount that Medicare paid after deductible and coinsurance amounts have been deducted for all the provider's line item services.$148,642.50
Total Medicare Standardized Payment Amount$156,070.62
Total number of HCPCS codes for drug services, as defined from the Medicare Part B Drug ASP File10
Total drug services, as defined from the Medicare Part B Drug ASP File294
Total Medicare beneficiaries receiving drug services, as defined from the Medicare Part B Drug ASP File.118
The total charges that the provider submitted for drug services, as defined from the Medicare Part B Drug ASP File.$14,872.00
The Medicare allowed amount for drug services, as defined from the Medicare Part B Drug ASP File. This figure is the sum of the amount Medicare pays, the deductible and coinsurance amounts that the beneficiary is responsible for paying, and any amounts that a third party is responsible for paying.$8,283.05
Total amount that Medicare paid after deductible and coinsurance amounts have been deducted for all the provider's line item drug services, as defined from the Medicare Part B Drug ASP File.$8,027.29
Total amount that Medicare paid after deductible and coinsurance amounts have been deducted for the line item drug service , as defined from the Medicare Part B Drug ASP File and after standardization of the Medicare payment has been applied. Standardization removes geographic differences in payment rates for individual services, such as those that account for local wages or input prices and makes Medicare payments across geographic areas comparable, so that differences reflect variation in factors such as physicians’ practice patterns and beneficiaries’ ability and willingness to obtain care.$8,027.30
Total number of HCPCS codes associated with medical (non-ASP) services53
Total medical (non-ASP) services2270
Total Medicare beneficiaries receiving medical (non-ASP) services459
The total charges that the provider submitted for medical services (non-ASP)$350,188.00
The Medicare allowed amount for medical (non-ASP) services. This figure is the sum of the amount Medicare pays, the deductible and coinsurance amounts that the beneficiary is responsible for paying, and any amounts that a third party is responsible for paying.$199,374.63
Total amount that Medicare paid after deductible and coinsurance amounts have been deducted for all the provider's line item medical (non-ASP) services$140,615.21
Total amount that Medicare paid after deductible and coinsurance amounts have been deducted for the line item medical (non-ASP) service , as defined from the Medicare Part B Drug ASP File and after standardization of the Medicare payment has been applied. Standardization removes geographic differences in payment rates for individual services, such as those that account for local wages or input prices and makes Medicare payments across geographic areas comparable, so that differences reflect variation in factors such as physicians’ practice patterns and beneficiaries’ ability and willingness to obtain care$148,043.32
Average age of beneficiaries74
Number of beneficiaries under the age of 6552
Number of beneficiaries between the ages of 65 and 74195
Number of beneficiaries between the ages of 75 and 84149
Number of beneficiaries over the age of 8463
Number of Female beneficiaries267
Number of Male Beneficiaries192
Number of Non-Hispanic White Beneficiaries434
Number of Medicare beneficiaries qualified to receive Medicare only benefits. Beneficiaries are classified as Medicare only entitlement if they received zero months of any Medicaid benefits (full or partial) in the given calendar year365
Number of Medicare beneficiaries qualified to receive Medicare and Medicaid benefits. Beneficiaries are classified as Medicare and Medicaid entitlement if in any month in the given calendar year they were receiving full or partial Medicaid benefits94
Percent of beneficiaries meeting the CCW chronic condition algorithm for atrial fibrillation21%
Percent of beneficiaries meeting the CCW chronic condition algorithm for Alzheimer’s, related disorders, or dementia15%
Percent of beneficiaries meeting the CCW chronic condition algorithm for Asthma7%
Percent of beneficiaries meeting the CCW chronic condition algorithms for cancer. Includes breast cancer, colorectal cancer, lung cancer and prostate cancer13%
Percent of beneficiaries meeting the CCW chronic condition algorithm for heart failure24%
Percent of beneficiaries meeting the CCW chronic condition algorithm for chronic kidney disease40%
Percent of beneficiaries meeting the CCW chronic condition algorithm for chronic obstructive pulmonary disease23%
Percent of beneficiaries meeting the CCW chronic condition algorithm for depression36%
Percent of beneficiaries meeting the CCW chronic condition algorithm for diabetes34%
Percent of beneficiaries meeting the CCW chronic condition algorithm for hyperlipidemia55%
Percent of beneficiaries meeting the CCW chronic condition algorithm for hypertension73%
Percent of beneficiaries meeting the CCW chronic condition algorithm for ischemic heart disease31%
Percent of beneficiaries meeting the CCW chronic condition algorithm for osteoporosis7%
Percent of beneficiaries meeting the CCW chronic condition algorithm for rheumatoid arthritis/osteoarthritis48%
Percent of beneficiaries meeting the CCW chronic condition algorithm for schizophrenia and other psychotic disorders6%
Percent of beneficiaries meeting the CCW chronic condition algorithm for stroke10%
Average Hierarchical Condition Category (HCC) risk score of beneficiaries1.5333

Source: data.cms.gov

Scott Kaple D.O.'s 2017 Charges to Medicare:

Services Description Times Provided Beneficiaries Beneficiaries per day Medicare Avg. Amt. Average Charge Avg Medicare Payment Percentage of Average
Destruction of skin growth 11 11 11 $61.38 $157.09 $34.37 457%
Aspiration and/or injection of large joint or joint capsule 28 17 25 $56.16 $119.0 $37.7 316%
Insertion of needle into vein for collection of blood sample 62 50 62 $3.0 $6.0 $2.89 207%
Urinalysis, manual test 12 12 12 $3.23 $7.0 $3.17 221%
Automated urinalysis test 35 27 35 $3.08 $7.0 $3.02 232%
Vaccine for influenza for injection into muscle 29 29 29 $49.03 $64.0 $48.05 133%
Pneumococcal vaccine for injection into muscle 24 24 24 $190.71 $308.0 $186.9 165%
Vaccine for influenza for administration into muscle, 0.5 ml dosage 42 42 42 $19.03 $39.0 $18.65 209%
Vaccine for pneumococcal polysaccharide for injection beneath the skin or into muscle, patient 2 years or older 12 12 12 $96.63 $156.0 $94.69 165%
Injection beneath the skin or into muscle for therapy, diagnosis, or prevention 24 19 22 $24.25 $42.0 $16.39 256%
Established patient office or other outpatient visit, typically 15 minutes 107 81 107 $70.93 $124.0 $41.73 297%
Established patient office or other outpatient, visit typically 25 minutes 1111 353 1111 $104.53 $183.0 $67.75 270%
Initial nursing facility visit, typically 35 minutes per day 36 30 36 $128.59 $229.0 $100.81 227%
Initial nursing facility visit, typically 35 minutes per day 24 23 24 $128.59 $229.0 $92.41 248%
Subsequent nursing facility visit, typically 25 minutes per day 25 19 25 $89.85 $156.0 $69.83 223%
Subsequent nursing facility visit, typically 25 minutes per day 71 27 71 $89.85 $156.0 $53.1 294%
Smoking and tobacco use intermediate counseling, greater than 3 minutes up to 10 minutes 11 11 11 $14.27 $24.0 $13.98 172%
Transitional care management services, moderately complexity, requiring face-to-face visits within 14 days of discharge 42 37 42 $158.47 $277.0 $113.9 243%
Transitional care management services, highly complexity, requiring face-to-face visits within 7 days of discharge 68 54 68 $224.33 $392.0 $173.76 226%
Administration of influenza virus vaccine 85 85 85 $24.25 $42.0 $23.76 177%
Administration of pneumococcal vaccine 38 38 38 $24.25 $42.0 $23.76 177%
Physician re-certification for medicare-covered home health services under a home health plan of care (patient not present), including contacts with home health agency and review of reports of patient status required by physicians to affirm the initial imp 12 11 12 $39.96 $70.0 $31.33 223%
Physician certification for medicare-covered home health services under a home health plan of care (patient not present), including contacts with home health agency and review of reports of patient status required by physicians to affirm the initial implem 56 46 56 $52.19 $90.0 $40.91 220%
Annual wellness visit; includes a personalized prevention plan of service (pps), initial visit 58 58 58 $167.05 $288.0 $163.71 176%
Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit 66 66 66 $112.77 $192.0 $108.84 176%
Source: 2017 Provider CMS Charge Data