New Charge Database Available to CAL/ACEP Members

[CAL/AAEM News Service]

New Charge Database Available to CAL/ACEP Members

Source: The American College of Emergency Physicians ( http://www.calacep.org )
Date: January 31, 2008 
 

The DHS has provided CAL/ACEP with a database of charges submitted by emergency
physicians to the Medi-Cal fee-for-service program in 2006, and this information is now
available for down-load from the CAL/ACEP website (www.calacep.org).  To download this
excel spreadsheet, click on the 'members only' link on the bottom left edge of the home
page, and enter the user ID 'Calacep' (notice the capitol 'C'), and the password
'simple'.  Once you get to the “Members Only” welcome page, please click on “Tools” at
the left-hand side of the welcome page.  You will find the file in the “Tools” page for
easy download to your computer.

A few words about this file:

The data is derived from over 750,000 claims submitted in 2006.  It is a pretty fair
representation of emergency physician charges in California, but there is not enough data
to make statistically significant regional distinctions in median charges.  Also, because
it is not possible to know for certain whether or not these charges were discounted when
-54 and other modifiers were submitted with the claim, about 15% of the surgical codes
submitted with such modifiers were omitted from the database.  The omission of these
codes did not seem to modify the mean charge rates to any significant degree, though the
average charge seemed to be about 5% lower for these modified codes, indicating some
likely penetration with discounted charges).  The charges associated with -26 modified
(professional service only) xray interpretation codes did seem to be discounted by the
vast majority of providers, and these codes are reported as modified.

In addition, when PA or NP providers claims were submitted with modifiers to E+M codes,
it was clear that many of these claims were submitted with discounted charges, so these
claims were also eliminated from the database.

The resulting data should represent a fairly accurate picture of non-discounted usual and
customary charges for Emergency Physician claims and service codes in 2006.  Where
certain codes and services were rarely performed, of course, the relative 'accuracy' of
mean, median and percentile charge calculations is substantially reduced.  Most providers
use CPT Relative Value Units to develop components of their fee schedule, especially for
surgical services, and it should be possible to extrapolate from the charges for commonly
provided services and codes to those that are rarely used by considering the RVUs
assigned to these codes.

Please keep in mind that the relative frequency of use of these codes for Medi-Cal
patients will likely be very, very different from the relative frequency of use for
commercial or Medicare patients.

Myles Riner, MD

CAL/ACEP


Abid Mogannam &
Brian Potts MD, MBA
Managing Editors, CAL/AAEM News Service
University of California, Irvine

The CAL/AAEM Archives are available at: http://maillists.uci.edu/mailman/public/calaaem/



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