Dawn Gore CNS

Gender: F
Medical School: Other
Graduation Year: 1992
Primary Specialty: Certified Clinical Nurse Specialist (cns)

2017 Medicare Provider Charge and Payment Data

Medicare Participation?Y
Number of unique HCPCS codes submitted10
Total Provider Services1719
Total Medicare beneficiaries receiving the provider services405
The total charges that the provider submitted for all services$378,119.00
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.$114,139.75
Total amount that Medicare paid after deductible and coinsurance amounts have been deducted for all the provider's line item services.$83,044.73
Total Medicare Standardized Payment Amount$85,796.84
Total number of HCPCS codes for drug services, as defined from the Medicare Part B Drug ASP File0
Total drug services, as defined from the Medicare Part B Drug ASP File0
Total Medicare beneficiaries receiving drug services, as defined from the Medicare Part B Drug ASP File.0
The total charges that the provider submitted for drug services, as defined from the Medicare Part B Drug ASP File.$0.00
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.$0.00
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.$0.00
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.$0.00
Total number of HCPCS codes associated with medical (non-ASP) services10
Total medical (non-ASP) services1719
Total Medicare beneficiaries receiving medical (non-ASP) services405
The total charges that the provider submitted for medical services (non-ASP)$378,119.00
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.$114,139.75
Total amount that Medicare paid after deductible and coinsurance amounts have been deducted for all the provider's line item medical (non-ASP) services$83,044.73
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$85,796.84
Average age of beneficiaries77
Number of beneficiaries under the age of 6570
Number of beneficiaries between the ages of 65 and 7485
Number of beneficiaries between the ages of 75 and 84116
Number of beneficiaries over the age of 84134
Number of Female beneficiaries256
Number of Male Beneficiaries149
Number of Non-Hispanic White Beneficiaries375
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 year156
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 benefits249
Percent of beneficiaries meeting the CCW chronic condition algorithm for atrial fibrillation24%
Percent of beneficiaries meeting the CCW chronic condition algorithm for Alzheimer’s, related disorders, or dementia59%
Percent of beneficiaries meeting the CCW chronic condition algorithm for Asthma8%
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 failure42%
Percent of beneficiaries meeting the CCW chronic condition algorithm for chronic kidney disease51%
Percent of beneficiaries meeting the CCW chronic condition algorithm for chronic obstructive pulmonary disease38%
Percent of beneficiaries meeting the CCW chronic condition algorithm for depression59%
Percent of beneficiaries meeting the CCW chronic condition algorithm for diabetes49%
Percent of beneficiaries meeting the CCW chronic condition algorithm for hyperlipidemia61%
Percent of beneficiaries meeting the CCW chronic condition algorithm for hypertension75%
Percent of beneficiaries meeting the CCW chronic condition algorithm for ischemic heart disease48%
Percent of beneficiaries meeting the CCW chronic condition algorithm for osteoporosis12%
Percent of beneficiaries meeting the CCW chronic condition algorithm for rheumatoid arthritis/osteoarthritis60%
Percent of beneficiaries meeting the CCW chronic condition algorithm for schizophrenia and other psychotic disorders28%
Percent of beneficiaries meeting the CCW chronic condition algorithm for stroke15%
Average Hierarchical Condition Category (HCC) risk score of beneficiaries2.7186

Source: data.cms.gov

Dawn Gore CNS's 2017 Charges to Medicare:

Services Description Times Provided Beneficiaries Beneficiaries per day Medicare Avg. Amt. Average Charge Avg Medicare Payment Percentage of Average
Initial nursing facility visit, typically 35 minutes per day 12 12 12 $109.3 $229.0 $85.69 267%
Subsequent nursing facility visit, typically 10 minutes per day 64 54 64 $37.31 $192.72 $17.37 1110%
Subsequent nursing facility visit, typically 15 minutes per day 181 90 181 $57.71 $275.18 $42.42 649%
Subsequent nursing facility visit, typically 15 minutes per day 609 233 609 $57.71 $251.32 $38.74 649%
Subsequent nursing facility visit, typically 25 minutes per day 85 54 85 $76.37 $247.49 $58.14 426%
Subsequent nursing facility visit, typically 25 minutes per day 651 188 651 $76.37 $175.16 $58.41 300%
Subsequent nursing facility visit, typically 35 minutes per day 20 18 20 $113.81 $232.0 $89.23 260%
Nursing facility discharge day management, 30 minutes or less 30 27 30 $61.37 $215.83 $46.52 464%
Nursing facility discharge day management, 30 minutes or less 29 27 29 $61.37 $158.9 $46.46 342%
Nursing facility discharge management, more than 30 minutes 13 13 13 $88.81 $318.77 $69.63 458%
Source: 2017 Provider CMS Charge Data