Charlene Breedlove

Gender: F
Medical School: Cincinnati College Of Medicine And Surgery
Graduation Year: 2013
Primary Specialty: Nurse Practitioner

2017 Medicare Provider Charge and Payment Data

Medicare Participation?Y
Number of unique HCPCS codes submitted14
Total Provider Services592
Total Medicare beneficiaries receiving the provider services288
The total charges that the provider submitted for all services$100,050.00
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.$47,621.02
Total amount that Medicare paid after deductible and coinsurance amounts have been deducted for all the provider's line item services.$35,581.92
Total Medicare Standardized Payment Amount$37,473.61
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) services14
Total medical (non-ASP) services592
Total Medicare beneficiaries receiving medical (non-ASP) services288
The total charges that the provider submitted for medical services (non-ASP)$100,050.00
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.$47,621.02
Total amount that Medicare paid after deductible and coinsurance amounts have been deducted for all the provider's line item medical (non-ASP) services$35,581.92
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$37,473.61
Average age of beneficiaries73
Number of beneficiaries under the age of 6553
Number of beneficiaries between the ages of 65 and 74106
Number of beneficiaries between the ages of 75 and 8492
Number of beneficiaries over the age of 8437
Number of Female beneficiaries174
Number of Male Beneficiaries114
Number of Non-Hispanic White Beneficiaries269
Number of Asian Pacific Islander Beneficiaries0
Number of American Indian/Alaska Native 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 year220
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 benefits68
Percent of beneficiaries meeting the CCW chronic condition algorithm for atrial fibrillation20%
Percent of beneficiaries meeting the CCW chronic condition algorithm for Alzheimer’s, related disorders, or dementia19%
Percent of beneficiaries meeting the CCW chronic condition algorithm for Asthma9%
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 failure27%
Percent of beneficiaries meeting the CCW chronic condition algorithm for chronic kidney disease45%
Percent of beneficiaries meeting the CCW chronic condition algorithm for chronic obstructive pulmonary disease34%
Percent of beneficiaries meeting the CCW chronic condition algorithm for depression38%
Percent of beneficiaries meeting the CCW chronic condition algorithm for diabetes40%
Percent of beneficiaries meeting the CCW chronic condition algorithm for hyperlipidemia70%
Percent of beneficiaries meeting the CCW chronic condition algorithm for hypertension75%
Percent of beneficiaries meeting the CCW chronic condition algorithm for ischemic heart disease46%
Percent of beneficiaries meeting the CCW chronic condition algorithm for osteoporosis11%
Percent of beneficiaries meeting the CCW chronic condition algorithm for rheumatoid arthritis/osteoarthritis67%
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 stroke12%
Average Hierarchical Condition Category (HCC) risk score of beneficiaries1.8648

Source: data.cms.gov

Charlene Breedlove's 2017 Charges to Medicare:

Services Description Times Provided Beneficiaries Beneficiaries per day Medicare Avg. Amt. Average Charge Avg Medicare Payment Percentage of Average
Hospital observation care discharge 43 42 43 $59.9 $125.0 $43.68 286%
Hospital observation care typically 70 minutes per day 27 26 27 $153.39 $321.0 $115.63 278%
Initial hospital inpatient care, typically 30 minutes per day 44 44 44 $83.94 $177.0 $65.81 269%
Initial hospital inpatient care, typically 50 minutes per day 25 25 25 $113.11 $240.0 $66.31 362%
Initial hospital inpatient care, typically 70 minutes per day 39 39 39 $165.9 $352.0 $125.29 281%
Subsequent hospital inpatient care, typically 25 minutes per day 301 181 301 $59.61 $125.0 $44.89 278%
Hospital discharge day management, more than 30 minutes 86 81 86 $88.39 $185.0 $67.15 276%
Source: 2017 Provider CMS Charge Data