Supplementary medical insurance benefit for physician and supplier services - Medicare and Medicaid Statistical Supplement

Health Care Financing Review, Annual, 1992 by Charles Helbing, John T. Petrie

As shown in Table 7.5, the number of active MDs and DOs who billed Medicare as of April 1991 was 471,804, or about 147 Medicare physicians per 10,000 Medicare enrollees. As of April 1991, the number of physicians and limited licensed practitioners (LLPs) who billed Medicare numbered 583,229, or 181 per 10,000 Medicare enrollees. (LLPs include doctors of dental medicine, dental surgery, pediatric medicine, and optometry, as well as chiropractors). The physicians and LLPs who billed Medicare were identified via a Medicare unique physician identification number (UPIN) established and maintained by the Medicare physician identification and eligibility system (MPIES). MPIES was mandated by COBRA 1985.

[TABULAR DATA 7.5 OMITTED]

The UPIN provides a unique identifier for each physician who renders and bills for covered services to Medicare beneficiaries. A unique identifier is assigned to each physician regardless of his or her practice configuration. Salaried physicians of health maintenance organizations that do not bill Medicare, and interns, residents, and some Public Health Service physicians are neither currently enumerated nor assigned a UPIN.

The number of Medicare MDs and DOs varied among geographic divisions of the United States as did the total U. S. physician population. In April 199 1, the number of physicians per 10,000 enrollees was highest in the Pacific Division (199) and in the New England Division (185) (Figure 7.6). By State, the highest physician supply per 10,000 enrollees was found in the District of Columbia (389), Alaska (284), Massachusetts (227), and California (214). In contrast, the number of physicians per 10,000 Medicare enrollees was low in the East South Central Division (I 14) and the West North Central Division (126). The lowest rates per 10,000 by State were in South Dakota (85), Mississippi (88), Kansas (95), Nebraska (96), and Arkansas (99).

Selected demographic characteristics: 1990

An estimated 27.6 million Medicare beneficiaries, or more than four-fifths of all Medicare enrollees (34.2 million), used SMI-covered physician and supplier services during 1990 (Table 7.7). They incurred Medicare-allowed charges amounting to $37.4 billion, an average of $1,356 per user.

Nearly 52 percent (13.0 million) of all aged Medicare beneficiaries (25.0 million) using covered physician services during 1990 were 65-74 years of age. However, the rate of use increased with age, rising from 774 per 1,000 enrollees for those beneficiaries 65-74 years of age, to 965 per 1,000 for those 85 years of age or over. The average allowed charge for the 65-74 age cohort was $1,224 per user, or about 22 percent lower than the average allowed charge for beneficiaries 75 years of age or over. Similarly, the average number of services (27.2) for the younger beneficiaries was about 26 percent lower than that for those 75 years of age or over. The average balance billing liability for aged beneficiaries in the 65-74 age group was $150 per user with liability. The average liability increased to $159 per user for beneficiaries 75-84 years of age and then dropped to $144 per user for those 85 years of age or over.