John Hughes M.D.

Gender: M
Medical School: University Of Toledo College Of Medicine
Graduation Year: 1994
Primary Specialty: Internal Medicine

2017 Medicare Provider Charge and Payment Data

Medicare Participation?Y
Number of unique HCPCS codes submitted53
Total Provider Services3230
Total Medicare beneficiaries receiving the provider services598
The total charges that the provider submitted for all services$443,878.00
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.$255,075.20
Total amount that Medicare paid after deductible and coinsurance amounts have been deducted for all the provider's line item services.$182,665.01
Total Medicare Standardized Payment Amount$192,442.77
Total number of HCPCS codes for drug services, as defined from the Medicare Part B Drug ASP File8
Total drug services, as defined from the Medicare Part B Drug ASP File229
Total Medicare beneficiaries receiving drug services, as defined from the Medicare Part B Drug ASP File.193
The total charges that the provider submitted for drug services, as defined from the Medicare Part B Drug ASP File.$30,403.00
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.$18,887.37
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.$18,459.70
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.$18,497.76
Total number of HCPCS codes associated with medical (non-ASP) services45
Total medical (non-ASP) services3001
Total Medicare beneficiaries receiving medical (non-ASP) services598
The total charges that the provider submitted for medical services (non-ASP)$413,475.00
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.$236,187.83
Total amount that Medicare paid after deductible and coinsurance amounts have been deducted for all the provider's line item medical (non-ASP) services$164,205.31
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$173,945.01
Average age of beneficiaries74
Number of beneficiaries under the age of 6551
Number of beneficiaries between the ages of 65 and 74260
Number of beneficiaries between the ages of 75 and 84214
Number of beneficiaries over the age of 8473
Number of Female beneficiaries323
Number of Male Beneficiaries275
Number of Non-Hispanic White Beneficiaries569
Number of American Indian/Alaska Native Beneficiaries0
Number of Beneficiaries With Race Not Elsewhere Classified17
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 year532
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 benefits66
Percent of beneficiaries meeting the CCW chronic condition algorithm for atrial fibrillation15%
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 Asthma7%
Percent of beneficiaries meeting the CCW chronic condition algorithms for cancer. Includes breast cancer, colorectal cancer, lung cancer and prostate cancer11%
Percent of beneficiaries meeting the CCW chronic condition algorithm for heart failure16%
Percent of beneficiaries meeting the CCW chronic condition algorithm for chronic kidney disease39%
Percent of beneficiaries meeting the CCW chronic condition algorithm for chronic obstructive pulmonary disease22%
Percent of beneficiaries meeting the CCW chronic condition algorithm for depression29%
Percent of beneficiaries meeting the CCW chronic condition algorithm for diabetes35%
Percent of beneficiaries meeting the CCW chronic condition algorithm for hyperlipidemia75%
Percent of beneficiaries meeting the CCW chronic condition algorithm for hypertension75%
Percent of beneficiaries meeting the CCW chronic condition algorithm for ischemic heart disease31%
Percent of beneficiaries meeting the CCW chronic condition algorithm for osteoporosis5%
Percent of beneficiaries meeting the CCW chronic condition algorithm for rheumatoid arthritis/osteoarthritis47%
Percent of beneficiaries meeting the CCW chronic condition algorithm for schizophrenia and other psychotic disorders2%
Percent of beneficiaries meeting the CCW chronic condition algorithm for stroke5%
Average Hierarchical Condition Category (HCC) risk score of beneficiaries1.2628

Source: data.cms.gov

John Hughes M.D.'s 2017 Charges to Medicare:

Services Description Times Provided Beneficiaries Beneficiaries per day Medicare Avg. Amt. Average Charge Avg Medicare Payment Percentage of Average
Automated urinalysis test 109 92 109 $3.08 $7.0 $2.97 236%
Urine microalbumin (protein) analysis 32 32 32 $6.28 $13.0 $5.46 238%
Blood test, clotting time 65 12 65 $5.39 $11.0 $5.28 208%
Detection test for influenza virus 23 12 12 $16.44 $33.0 $16.11 205%
Vaccine for influenza for injection into muscle 64 64 64 $49.03 $64.0 $48.05 133%
Pneumococcal vaccine for injection into muscle 69 69 69 $188.44 $308.0 $184.68 167%
Vaccine for influenza for administration into muscle, 0.5 ml dosage 69 69 69 $19.03 $39.0 $18.11 215%
Vaccine for pneumococcal polysaccharide for injection beneath the skin or into muscle, patient 2 years or older 14 14 14 $98.85 $156.0 $96.87 161%
Routine EKG using at least 12 leads including interpretation and report 37 35 37 $16.37 $29.0 $10.06 288%
Injection beneath the skin or into muscle for therapy, diagnosis, or prevention 31 11 31 $24.25 $42.0 $17.28 243%
Established patient office or other outpatient visit, typically 15 minutes 504 279 504 $70.93 $124.0 $41.19 301%
Established patient office or other outpatient, visit typically 25 minutes 1233 506 1233 $104.53 $183.0 $66.48 275%
Initial nursing facility visit, typically 35 minutes per day 18 16 18 $128.59 $229.0 $100.81 227%
Initial nursing facility visit, typically 45 minutes per day 15 13 15 $164.73 $290.0 $129.14 225%
Subsequent nursing facility visit, typically 25 minutes per day 38 15 38 $89.85 $156.0 $70.44 221%
Nursing facility discharge day management, 30 minutes or less 11 11 11 $72.2 $126.0 $56.6 223%
Transitional care management services, moderately complexity, requiring face-to-face visits within 14 days of discharge 87 72 87 $158.47 $277.0 $121.8 227%
Transitional care management services, highly complexity, requiring face-to-face visits within 7 days of discharge 34 32 34 $224.33 $392.0 $175.87 223%
Administration of influenza virus vaccine 161 160 161 $24.25 $42.0 $23.76 177%
Administration of pneumococcal vaccine 84 83 84 $24.25 $42.0 $23.76 177%
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 47 39 47 $52.19 $90.0 $40.91 220%
Annual wellness visit; includes a personalized prevention plan of service (pps), initial visit 88 88 88 $166.85 $288.0 $161.66 178%
Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit 44 44 44 $110.39 $192.0 $108.18 177%
Annual alcohol misuse screening, 15 minutes 124 124 124 $17.36 $30.0 $17.01 176%
Annual depression screening, 15 minutes 37 37 37 $17.36 $30.0 $17.01 176%
Source: 2017 Provider CMS Charge Data