787 results match your criteria billing claims

Decreased Colorectal Cancer Incidence and Incidence-Based Mortality in the Screening-Age Population of Ontario.

J Can Assoc Gastroenterol 2021 Jun 15;4(3):146-155. Epub 2020 Oct 15.

Department of Medicine, University of Toronto, Toronto, Ontario, Canada.

Background And Aims: We aimed to evaluate trends in Ontario, Canada, 2002 to 2016, in uptake of colorectal evaluative procedures, colorectal cancer (CRC) incidence and incidence-based mortality in the colorectal screening-age population.

Methods: We defined the screening age-eligible population as persons 51 to 74 years of age with ≥1 year eligibility for the Ontario Health Insurance Plan, excluding those with a diagnosis of CRC in the Ontario Cancer Registry (OCR) prior to age 50 or January 1, 2002. We computed annual up-to-date status with colorectal evaluative procedures from billing claims, and CRC incidence from the OCR. Read More

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Do Skilled Nursing Facilities That Provide More Rehabilitation Therapy Have Lower Rehospitalization Rates?

Am J Med Qual 2021 May 27. Epub 2021 May 27.

Department of Population Health Sciences, Weill Cornell Medical College, New York, NY.

This study examines whether skilled nursing facilities (SNFs) that consistently provided more rehabilitation therapy than other SNFs had lower 30-day rehospitalization rates. A cross-sectional analysis of 11 866 SNFs in the United States compared 30-day rehospitalization rates of SNFs that consistently provided more rehabilitation therapy to other SNFs using linear regression models. High-billing SNFs were defined as the 10% of SNFs with the highest proportions of Medicare fee-for-service claims that just surpassed the therapy minute threshold for the highest payment category. Read More

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Evaluating the Cost-Effectiveness of Celecoxib versus Ibuprofen and Naproxen in Patients with Osteoarthritis in United Arab Emirates Based on the PRECISION Trial.

Clinicoecon Outcomes Res 2021 19;13:409-420. Epub 2021 May 19.

Dubai Medical College, Dubai, United Arab Emirates.

Objective: Data on osteoarthritis patients from the PRECISION trial were used to evaluate the cost-effectiveness of celecoxib (100 mg twice daily) versus ibuprofen (600-800 mg three times daily) and naproxen (375-500 mg twice daily). The perspective was that of the United Arab Emirates (UAE) healthcare system.

Methods: Discrete-state Markov model with monthly cycles, 30-month horizon, and 3% discount rate was constructed to assess incremental costs per quality adjusted life year (QALYs) gained from reduced incidence of three safety domains examined in PRECISION: renal, serious gastrointestinal (GI), and major adverse cardiovascular events (MACE). Read More

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Validation of Claims Data for the Identification of Intraoperative Transesophageal Echocardiography During Cardiac Surgery.

J Cardiothorac Vasc Anesth 2021 Apr 22. Epub 2021 Apr 22.

Department of Anesthesiology and Critical Care, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.

Objective: The goal of this study was to assess the validity of Current Procedural Terminology (CPT) claims data for the identification of intraoperative transesophageal echocardiography (TEE) during cardiac surgery.

Design: This study was a retrospective, cohort analysis.

Setting: This study used data from electronic medical records (EMRs), in combination with CPT billing claims data, from two hospitals within the Penn Medicine Health System-Penn Presbyterian Medical Center and the Hospital of the University of Pennsylvania. Read More

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Advance care planning among Medicare beneficiaries with dementia undergoing surgery.

J Am Geriatr Soc 2021 May 20. Epub 2021 May 20.

Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA.

Importance: Advance care planning (ACP), in which patients or their surrogates discuss goals and preferences for care with physicians, attorneys, friends, and family, is an important approach to help align goals with actual treatment. ACP may be particularly valuable in patients with advanced serious illnesses such as Alzheimer's disease and related dementias (ADRDs) for whom surgery carries significant risks.

Objective: To determine the frequency, timing, and factors associated with ACP billing in Medicare beneficiaries with ADRD undergoing nontrauma inpatient surgery. Read More

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A population-based study to develop juvenile arthritis case definitions for administrative health data using model-based dynamic classification.

BMC Med Res Methodol 2021 May 16;21(1):105. Epub 2021 May 16.

Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, S113-750 Bannatyne Avenue, R3E 0W3, Winnipeg, Canada.

Background: Previous research has shown that chronic disease case definitions constructed using population-based administrative health data may have low accuracy for ascertaining cases of episodic diseases such as rheumatoid arthritis, which are characterized by periods of good health followed by periods of illness. No studies have considered a dynamic approach that uses statistical (i.e. Read More

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Developmental hip dysplasia and hip ultrasound frequency in a large American payer database.

Clin Imaging 2021 May 5;76:213-216. Epub 2021 May 5.

School of Economics, Georgia Institute of Technology, Atlanta, GA, USA; Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA, USA.

Developmental dysplasia of the hip (DDH) is an important contributor to musculoskeletal morbidity, but effective strategies to screen for DDH remain controversial. The current utilization of hip ultrasound (US) screening for DDH in the United States is not defined. This study utilized Optum's de-identified Clinformatics® Data Mart, a large commercial and Medicare Advantage claims database. Read More

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The Financial Implications of Telehealth Visits Within a Hand and Wrist Surgery Clinical Practice During the COVID-19 Pandemic.

J Hand Surg Am 2021 Apr 6. Epub 2021 Apr 6.

Rothman Orthopaedic Institute, Philadelphia, PA; Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA. Electronic address:

Purpose: Telehealth use is likely to increase as a result of practice changes during the COVID-19 pandemic, although the overall picture surrounding the billing, coding, and continued insurance coverage of these visits remains uncertain. The purpose of this study was to identify potential financial implications of continued telehealth use in hand and wrist surgery clinical practice.

Methods: Two hundred telehealth visits were randomly selected and matched 1:1 based on primary diagnosis code to in-person visits. Read More

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Mortality, Kidney Failure, and Hospitalization Among Medicare Beneficiaries With CKD and Pulmonary Hypertension.

Am J Kidney Dis 2021 Apr 24. Epub 2021 Apr 24.

Selzman Institute for Kidney Health, Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA.

Rationale And Objectives: Pulmonary hypertension (PH) is highly prevalent among patients with non-dialysis dependent CKD. We studied the associations of PH with mortality, kidney failure, as well as cardiovascular (CV) and non-CV hospitalization among Medicare beneficiaries diagnosed with CKD.

Setting: and Participants: Patients with PH (based on two claims within 2 years) and patients without PH matched on CKD stage from the Medicare 5% CKD sample (1996-2016). Read More

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Incidence, Clinical Correlates, and Outcomes of Pulmonary Hypertension after Kidney Transplantation: Analysis of Linked U.S. Registry and Medicare Billing Claims.

Transplantation 2021 Apr 9. Epub 2021 Apr 9.

Saint Louis University, St. Louis, MO, USA University of Calgary, Calgary, AB, Canada University of Iowa, Iowa City, IA, USA Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA UT Health, San Antonio, TX, USA University of Wisconsin, Madison, WI, USA University of Chicago, Chicago, IL, USA Einstein Medical Center, Philadelphia, PA, USA Weill Cornell Medicine, New York, NY, USA Hennepin County Medical Center, Minneapolis, MN, USA University Virginia, Charlottesville, VA, USA.

Background: The incidence, risks, and outcomes associated with pulmonary hypertension (P-HTN) in the kidney transplant (KTx) population are not well described.

Methods: We linked U.S. Read More

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Receipt of anticoagulation after venous thromboembolism diagnoses during delivery hospitalizations.

J Matern Fetal Neonatal Med 2021 Apr 15:1-3. Epub 2021 Apr 15.

Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, NY, USA.

Introduction: Obstetric venous thromboembolism (VTE) is a leading cause of maternal mortality. While hospital discharge data provide a readily accessible means of studying this relatively rare outcome, diagnosis codes are of limited validity. Prior studies have demonstrated that VTE billing codes may be subject to misclassification and false positives and overestimate obstetric VTE risk. Read More

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Provision of Collaborative Care Model and General Behavioral Health Integration Services in Medicare.

Psychiatr Serv 2021 Apr 15:appips202000265. Epub 2021 Apr 15.

Department of Medicine (Marcotte, Reddy, Zhou, Liao) and Department of Psychiatry and Behavioral Science (Razliff, Unützer, Chang), School of Medicine, University of Washington, Seattle; Value and Systems Science Lab, Seattle (Marcotte, Reddy, Zhou, Liao).

Objective: The authors sought to describe the early use of collaborative care model (CoCM) and general behavioral health integration (BHI) billing codes among clinicians.

Methods: Counts and payments were calculated for accepted and denied claims for CoCM and general BHI services delivered to Medicare beneficiaries nationwide in 2017-2018. Payment and utilization data were stratified by clinical specialty and site of service. Read More

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Contributions of Real-World Evidence and Real-World Data to Decision-Making in the Management of Soft Tissue Sarcomas.

Oncology 2021 14;99 Suppl 1:3-7. Epub 2021 Apr 14.

Cancer Medicine, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy.

Real-world data are defined as data relating to any aspect of a patient's health status collected in the context of routine health surveillance and medical care delivery. Sources range from insurance billing claims through to electronic surveillance data (e.g. Read More

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Provision of Dermatologic Care in a Universal Health Care System: A 17-Year Review.

J Cutan Med Surg 2021 Apr 11:12034754211008164. Epub 2021 Apr 11.

Division of Dermatology, Department of Medicine, University of Toronto, Toronto, ON, Canada.

Background: Limited data is available on the burden of dermatologic disease including disease distribution and providers of care. Research is needed to facilitate health care planning and improve patient care.

Objectives: To investigate the demographics and economics of the provision of dermatologic care in a universal health care system from fiscal year 2000 to 2016. Read More

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Understanding Active Surveillance for Prostate Cancer.

JCO Oncol Pract 2021 Apr 8:OP2000929. Epub 2021 Apr 8.

Department of Urology, University of Michigan, Ann Arbor, MI.

Purpose: To assess how active surveillance for prostate cancer is apportioned across specialties and how testing patterns and transition to treatment vary by specialty.

Methods: We used a 20% national sample of Medicare claims to identify men diagnosed with prostate cancer from 2010 through 2016 initiating surveillance (N = 13,048). Patients were assigned to the physician responsible for the bulk of surveillance care based on billing patterns. Read More

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Medical Device Firm Payments To Physicians Exceed What Drug Companies Pay Physicians, Target Surgical Specialists.

Health Aff (Millwood) 2021 04;40(4):603-612

Ashley Swanson is an assistant professor at the Columbia Business School, in New York, New York.

Many physicians receive payments from medical device companies that make products physicians can use or recommend. Such payments are controversial because of concerns that they might influence physicians to treat patients with devices made by the firms that make those payments, even if those devices are not optimal for patients. This issue has been studied extensively in the drug industry. Read More

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A scoring model to detect abusive medical institutions based on patient classification system: Diagnosis-related group and ambulatory patient group.

J Biomed Inform 2021 May 26;117:103752. Epub 2021 Mar 26.

Department of Industrial Engineering & Institute for Industrial Systems Innovation, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul 08826, Republic of Korea. Electronic address:

The detection of medical abuse is essential because medical abuse imposes extra payments on individual insurance fees and increases unnecessary social costs. To reduce the costs due to medical abuse, insurance companies hire medical experts who examine claims, suspected to arise as a result of overtreatment from institutions, and review the suitability of claimed treatments. Owing to the limited number of reviewers and mounting volume of claims, there is need for a comprehensive method to detect medical abuse that uses a scoring model that selects a few institutions to be investigated. Read More

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Real-world evidence costs of allergic rhinitis and allergy immunotherapy in the commercially insured United States population.

Curr Med Res Opin 2021 Jun 2;37(6):957-965. Epub 2021 Apr 2.

ALK-Abelló, Hørsholm, Denmark.

Objective: To assess total and allergic rhinitis (AR)-related healthcare costs among AR patients residing in the United States with a focus on patients persisting with AIT.

Methods: AR patients were identified in the IBM MarketScan database between 1 January 2014 to 31 March 2017. Patients receiving allergy immunotherapy (AIT) were identified with relevant billing codes (earliest AIT claim = index date); non-AIT patients were identified with claims containing a diagnosis code for AR (earliest AR claim = index date). Read More

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Unsolicited patient complaints among radiation, medical, and surgical oncologists.

Cancer 2021 Jul 16;127(13):2350-2357. Epub 2021 Mar 16.

Center for Patient and Professional Advocacy, Vanderbilt University Medical Center, Nashville, Tennessee.

Background: Unsolicited patient complaints (UPCs) about physician practices are nonrandomly associated with malpractice claims and clinical quality. The authors evaluated the distributions and types of UPCs associated with oncologists by specialty and assessed oncologist characteristics associated with UPCs.

Methods: This retrospective study reviewed UPCs associated with US radiation oncologists (ROs), medical oncologists (MOs), and surgical oncologists (SOs) from 35 health care systems from 2015 to 2018. Read More

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The Association between Hospital-Physician Vertical Integration and Outpatient Physician Prices Paid by Commercial Insurers: New Evidence.

Inquiry 2021 Jan-Dec;58:46958021991276

University of California, Berkeley, CA, USA.

This study assessed the relationship between hospital ownership of physician organizations (known as hospital-physician vertical integration) and facility fees billed to commercial insurers and physician service prices. Healthcare claims came from the IBM® MarketScan® Commercial Database (2012-2016, N = 30,716,800 office visit claims [CPT codes 99211-99215]), and hospital-physician vertical integration measures were from SK&A Office Based Physicians Database provided by IQVIA. Multi-variate, fixed-effect models were used to regress prices on market-level hospital-physician vertical integration; models included geographic market and year fixed effects, claim-level variables, and time-varying market-level variables. Read More

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Physiotherapy utilisation and costs before lumbar spine surgery: a retrospective analysis of workers compensation claims in Australia.

BMC Musculoskelet Disord 2021 Mar 6;22(1):248. Epub 2021 Mar 6.

Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, NSW, Australia.

Background: Understanding how much physiotherapy people receive before lumbar spine surgery could give insight into what people and clinicians consider an adequate trial of non-operative management. The aim of this study was to investigate physiotherapy utilisation and costs before lumbar spine surgery under a workers' compensation claim in New South Wales (NSW), Australia.

Methods: Using data from the NSW State Insurance Regulatory Authority, we audited physiotherapy billing codes used before surgery for people who received lumbar spine surgery from 2010 to 2018. Read More

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Racial Disparities in Diagnosis of Attention-Deficit/Hyperactivity Disorder in a US National Birth Cohort.

JAMA Netw Open 2021 03 1;4(3):e210321. Epub 2021 Mar 1.

Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota.

Importance: There are limited data on the racial disparities in the incidence of attention-deficit/hyperactivity disorder (ADHD) diagnosis in children at the national level.

Objective: To explore differences in rates of diagnosis of ADHD and use of treatment among children by race and ethnicity.

Design, Setting, And Participants: This retrospective cohort study assessed insurance claims data of children born in the US between January 1, 2006, and December 31, 2012, who had continuous insurance coverage for at least 4 years. Read More

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Hospital-physician integration and Medicare's site-based outpatient payments.

Health Serv Res 2021 Feb;56(1):7-15

School of Public Health, University of Michigan, Ann Arbor, Michigan, USA.

Objective: To determine the relationship between Medicare's site-based outpatient billing policy and hospital-physician integration.

Data Sources: National Medicare claims data from 2010 to 2016.

Study Design: For each physician-year, we calculated the disparity between Medicare reimbursement under hospital ownership and under physician ownership. Read More

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February 2021

Urology Workforce Changes and Implications for Prostate Cancer Care Among Medicare Enrollees.

Urology 2021 Feb 19. Epub 2021 Feb 19.

Division of Health Services Research, Department of Urology, University of Michigan.

Objective: To characterize national trends in urologist workforce, practice organization, and management of incident prostate cancer.

Methods: Using Medicare claims data from 2010 to 2016, we identified all urologists billing Medicare and the practice with which they were affiliated. We characterized groups as solo, small single specialty, large single specialty, multispecialty, specialist, or hospital-owned practices. Read More

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February 2021

Concurrent prescriptions for opioids and benzodiazepines and risk of opioid overdose: protocol for a retrospective cohort study using linked administrative data.

BMJ Open 2021 02 18;11(2):e042299. Epub 2021 Feb 18.

McGill Clinical and Health Informatics, McGill University, Montréal, Quebec, Canada.

Introduction: Opioid overdoses have increased substantially over the last 20 years, with over 400 000 deaths in North America. While opioid prescribing has been a target of research, benzodiazepine and opioid co-intoxication has emerged as a potential risk factor. Our aim was to assess the risk of opioid overdose associated with concurrent use of opioids and benzodiazepines relative to opioids alone. Read More

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February 2021

Implementation of Shared Decision Making for Lung Cancer Screening Among the Privately Insured Nonelderly.

MDM Policy Pract 2021 Jan-Jun;6(1):2381468320984773. Epub 2021 Jan 27.

Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas.

The Centers for Medicare & Medicaid Services requires a written order of shared decision making (SDM) visit in its coverage policy for low-dose computed tomography (LDCT) for lung cancer screening (LCS). With screening eligibility starting at age 55, private insurance plans will likely adopt this coverage policy. This study examined the implementation of SDM in the context of LCS among the privately insured. Read More

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January 2021

Virtual care use before and during the COVID-19 pandemic: a repeated cross-sectional study.

CMAJ Open 2021 Jan-Mar;9(1):E107-E114. Epub 2021 Feb 17.

Women's College Hospital Institute for Health Systems Solutions and Virtual Care (Bhatia, Chu, Tadrous, Stamenova), Women's College Hospital; ICES Central (Bhatia, Pang); Leslie Dan Faculty of Pharmacy (Tadrous), University of Toronto; Division of General Internal Medicine and Geriatrics (Cram), Sinai Health System and University Health Network; Department of Medicine (Cram), University of Toronto, Toronto, Ont.

Background: The coronavirus disease 2019 (COVID-19) pandemic is thought to have increased use of virtual care, but population-based studies are lacking. We aimed to assess the uptake of virtual care during the COVID-19 pandemic using comprehensive population-based data from Ontario.

Methods: This was a repeated cross-sectional study design. Read More

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February 2021

Breaking Barriers: Studying Fracture Healing in the BONES Program.

J Orthop Trauma 2021 03;35(Suppl 1):S22-S27

Department of Orthopaedics, Louisiana State University Health Sciences Center, New Orleans, LA.

Summary: The Bioventus Observational Noninterventional EXOGEN Studies (BONES) Program includes 3 concurrent studies designed to estimate the incidence of fracture nonunions in patients treated with the EXOGEN Ultrasound Bone Healing System compared with those receiving standard fracture care. This article outlines the design and methodology within the fifth metatarsal fracture study; similar approaches are taken in the second and third BONES Program studies, which examine nonunions of the tibia and scaphoid. The BONES Program is an external comparator design and incorporates several unique, fit-for-purpose components to strengthen the approach and allow it to be submitted to the US Food and Drug Administration (FDA) to be considered for a label expansion. Read More

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End-of-life outcomes with or without early palliative care: a propensity score matched, population-based cancer cohort study.

BMJ Open 2021 02 12;11(2):e041432. Epub 2021 Feb 12.

Department of Oncology, University of Calgary, Calgary, Alberta, Canada.

Objectives: To investigate whether cancer decedents who received palliative care early (ie, >6 months before death) and not-early had different risk of using hospital care and supportive home care in the last month of life.

Design/setting: We identified a population-based cohort of cancer decedents between 2004 and 2014 in Ontario, Canada using linked administrative data. Analysis occurred between August 2017 to March 2019. Read More

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February 2021

Improving Cervical Precancer Surveillance: Validity of Claims-Based Prediction Models in ICD-9 and ICD-10 Eras.

JNCI Cancer Spectr 2021 Feb 30;5(1):pkaa112. Epub 2020 Dec 30.

Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.

Background: Human papillomavirus vaccine (HPV) impact on cervical precancer (cervical intraepithelial neoplasia grades 2+ [CIN2+]) is observable sooner than impact on cancer. Biopsy-confirmed CIN2+ is not included in most US cancer registries. Billing codes could provide surrogate metrics; however, the International Classification of Diseases, ninth (ICD-9) to tenth (ICD-10) transition disrupts trends. Read More

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February 2021