Table 6. Distribution of hospital outpatient department claims and charges, by type of service.
Type of service | Number of claims | Percentage of claims | Percentage of charges | Average charge1 |
---|---|---|---|---|
Routine visits | 48,610 | 10.3 | 5.3 | $80.81 |
Emergency department visits | 51,461 | 10.9 | 3.8 | 55.40 |
Consultations or specialty services | 26,116 | 5.6 | 3.1 | 89.66 |
Other visits | 1,755 | 0.4 | 0.3 | 121.99 |
Cataract-lens procedures | 8,241 | 1.2 | 12.6 | 1,157.88 |
Other eye procedures | 4,269 | 0.9 | 0.2 | 267.67 |
Other ambulatory procedures | 6,048 | 1.3 | 2.8 | 356.70 |
Minor procedures | 12,195 | 2.3 | 2.3 | 145.19 |
Major procedures | 2,197 | 0.5 | 1.2 | 539.46 |
Endoscopy procedures | 15,051 | 3.2 | 5.7 | 287.27 |
Imaging procedures | 1,842 | 0.4 | 1.2 | 725.88 |
Advanced imaging | 24,418 | 5.2 | 13.6 | 424.28 |
Standard imaging | 116,035 | 24.7 | 16.4 | 107.66 |
Sonography | 16,358 | 3.5 | 3.7 | 171.70 |
Oncology services | 9,593 | 2.0 | 6.2 | 490.83 |
Dialysis services | 1,151 | 0.2 | 2.3 | 21,508.20 |
Laboratory tests | 99,180 | 21.1 | 12.4 | 95.28 |
Other tests | 20,660 | 4.4 | 3.6 | 132.51 |
Other | 4,806 | 1.0 | 1.2 | 190.84 |
All averages are claims-weighted.
Analysis of claims data indicates that facilities report an average of 12 treatments per claim. If submitted separately, about 11,000 additional dialysis claims (about 2 percent of all claims) would be reported with an average charge of approximately $126.
SOURCES: Health Care Financing Administration: Hospital Outpatient Bill file and Part B Medicare Annual Data file, both 1987; data development by the Urban Institute.