Seth Ruggles DO

Gender: M
Medical School: Ohio University, College Of Osteopathic Medicine
Graduation Year: 2004
Primary Specialty: Family Medicine

2017 Medicare Provider Charge and Payment Data

Medicare Participation?Y
Number of unique HCPCS codes submitted34
Total Provider Services1538
Total Medicare beneficiaries receiving the provider services264
The total charges that the provider submitted for all services$165,710.00
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.$106,240.94
Total amount that Medicare paid after deductible and coinsurance amounts have been deducted for all the provider's line item services.$78,033.24
Total Medicare Standardized Payment Amount$81,705.73
Total number of HCPCS codes for drug services, as defined from the Medicare Part B Drug ASP File6
Total drug services, as defined from the Medicare Part B Drug ASP File140
Total Medicare beneficiaries receiving drug services, as defined from the Medicare Part B Drug ASP File.64
The total charges that the provider submitted for drug services, as defined from the Medicare Part B Drug ASP File.$11,336.00
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.$5,447.84
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.$5,302.57
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.$5,302.57
Total number of HCPCS codes associated with medical (non-ASP) services28
Total medical (non-ASP) services1398
Total Medicare beneficiaries receiving medical (non-ASP) services264
The total charges that the provider submitted for medical services (non-ASP)$154,374.00
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.$100,793.10
Total amount that Medicare paid after deductible and coinsurance amounts have been deducted for all the provider's line item medical (non-ASP) services$72,730.67
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$76,403.16
Average age of beneficiaries70
Number of beneficiaries under the age of 6544
Number of beneficiaries between the ages of 65 and 74133
Number of beneficiaries between the ages of 75 and 8466
Number of beneficiaries over the age of 8421
Number of Female beneficiaries134
Number of Male Beneficiaries130
Number of Non-Hispanic White Beneficiaries249
Number of Asian Pacific Islander Beneficiaries0
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 year221
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 benefits43
Percent of beneficiaries meeting the CCW chronic condition algorithm for atrial fibrillation9%
Percent of beneficiaries meeting the CCW chronic condition algorithm for Alzheimer’s, related disorders, or dementia7%
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 failure12%
Percent of beneficiaries meeting the CCW chronic condition algorithm for chronic kidney disease28%
Percent of beneficiaries meeting the CCW chronic condition algorithm for chronic obstructive pulmonary disease14%
Percent of beneficiaries meeting the CCW chronic condition algorithm for depression14%
Percent of beneficiaries meeting the CCW chronic condition algorithm for diabetes32%
Percent of beneficiaries meeting the CCW chronic condition algorithm for hyperlipidemia28%
Percent of beneficiaries meeting the CCW chronic condition algorithm for hypertension55%
Percent of beneficiaries meeting the CCW chronic condition algorithm for ischemic heart disease24%
Percent of beneficiaries meeting the CCW chronic condition algorithm for rheumatoid arthritis/osteoarthritis38%
Percent of beneficiaries meeting the CCW chronic condition algorithm for stroke6%
Average Hierarchical Condition Category (HCC) risk score of beneficiaries1.0186

Source: data.cms.gov

Seth Ruggles 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
Removal of impact ear wax, one ear 12 11 12 $47.79 $96.0 $36.07 266%
Automated urinalysis test 46 32 46 $3.08 $15.0 $3.02 497%
Hemoglobin A1C level 246 115 246 $13.32 $32.0 $13.0 246%
Pneumococcal vaccine for injection into muscle 23 23 23 $186.6 $373.0 $182.87 204%
Vaccine for influenza for administration into muscle, 0.5 ml dosage 41 41 41 $17.84 $39.0 $17.48 223%
Established patient office or other outpatient visit, typically 15 minutes 437 206 437 $70.93 $105.0 $41.28 254%
Established patient office or other outpatient, visit typically 25 minutes 359 158 359 $104.53 $157.0 $69.75 225%
Administration of influenza virus vaccine 41 41 41 $24.25 $25.0 $23.76 105%
Administration of pneumococcal vaccine 24 24 24 $24.25 $25.0 $23.76 105%
Annual wellness visit; includes a personalized prevention plan of service (pps), initial visit 110 110 110 $167.05 $251.0 $163.71 153%
Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit 17 17 17 $112.77 $169.0 $110.51 153%
Source: 2017 Provider CMS Charge Data