Charles House DO

Gender: M
Medical School: University Of New England, College Of Osteo Medicine
Graduation Year: 1985
Primary Specialty: General Practice

2017 Medicare Provider Charge and Payment Data

Medicare Participation?Y
Number of unique HCPCS codes submitted12
Total Provider Services607
Total Medicare beneficiaries receiving the provider services217
The total charges that the provider submitted for all services$75,577.00
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.$43,027.92
Total amount that Medicare paid after deductible and coinsurance amounts have been deducted for all the provider's line item services.$25,317.19
Total Medicare Standardized Payment Amount$29,857.92
Total number of HCPCS codes for drug services, as defined from the Medicare Part B Drug ASP File1
Total drug services, as defined from the Medicare Part B Drug ASP File21
Total Medicare beneficiaries receiving drug services, as defined from the Medicare Part B Drug ASP File.19
The total charges that the provider submitted for drug services, as defined from the Medicare Part B Drug ASP File.$420.00
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.$231.39
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.$130.05
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.$130.05
Total number of HCPCS codes associated with medical (non-ASP) services11
Total medical (non-ASP) services586
Total Medicare beneficiaries receiving medical (non-ASP) services217
The total charges that the provider submitted for medical services (non-ASP)$75,157.00
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.$42,796.53
Total amount that Medicare paid after deductible and coinsurance amounts have been deducted for all the provider's line item medical (non-ASP) services$25,187.14
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$29,727.87
Average age of beneficiaries66
Number of beneficiaries under the age of 6563
Number of beneficiaries between the ages of 65 and 74112
Number of beneficiaries between the ages of 75 and 8430
Number of beneficiaries over the age of 8412
Number of Female beneficiaries116
Number of Male Beneficiaries101
Number of Non-Hispanic White Beneficiaries193
Number of Asian Pacific Islander Beneficiaries0
Number of American Indian/Alaska Native Beneficiaries0
Number of Beneficiaries With Race Not Elsewhere Classified11
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 year158
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 benefits59
Percent of beneficiaries meeting the CCW chronic condition algorithm for atrial fibrillation6%
Percent of beneficiaries meeting the CCW chronic condition algorithm for Asthma5%
Percent of beneficiaries meeting the CCW chronic condition algorithms for cancer. Includes breast cancer, colorectal cancer, lung cancer and prostate cancer8%
Percent of beneficiaries meeting the CCW chronic condition algorithm for heart failure11%
Percent of beneficiaries meeting the CCW chronic condition algorithm for chronic kidney disease18%
Percent of beneficiaries meeting the CCW chronic condition algorithm for chronic obstructive pulmonary disease20%
Percent of beneficiaries meeting the CCW chronic condition algorithm for depression19%
Percent of beneficiaries meeting the CCW chronic condition algorithm for diabetes35%
Percent of beneficiaries meeting the CCW chronic condition algorithm for hyperlipidemia16%
Percent of beneficiaries meeting the CCW chronic condition algorithm for hypertension42%
Percent of beneficiaries meeting the CCW chronic condition algorithm for ischemic heart disease24%
Percent of beneficiaries meeting the CCW chronic condition algorithm for osteoporosis5%
Percent of beneficiaries meeting the CCW chronic condition algorithm for rheumatoid arthritis/osteoarthritis38%
Average Hierarchical Condition Category (HCC) risk score of beneficiaries0.9398

Source: data.cms.gov

Charles House DO's 2017 Charges to Medicare:

Services Description Times Provided Beneficiaries Beneficiaries per day Medicare Avg. Amt. Average Charge Avg Medicare Payment Percentage of Average
Urinalysis, manual test 15 12 15 $3.23 $15.0 $3.02 496%
New patient office or other outpatient visit, typically 30 minutes 18 18 18 $99.91 $150.0 $49.39 304%
Established patient office or other outpatient visit, typically 15 minutes 480 180 480 $67.42 $125.0 $37.74 331%
Established patient office or other outpatient, visit typically 25 minutes 38 31 38 $99.36 $140.0 $59.37 236%
Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit 14 14 14 $107.2 $175.0 $102.96 170%
Injection, methylprednisolone acetate, 80 mg 21 19 21 $11.02 $20.0 $6.19 323%
Source: 2017 Provider CMS Charge Data