Rates, amounts, and determinants of ambulatory blood pressure monitoring claim reimbursements among Medicare beneficiaries

Shia T Kent; Daichi Shimbo; Lei Huang; Keith M Diaz; Anthony J Viera; Meredith Kilgore; Suzanne Oparil; Paul Muntner

doi:10.1016/j.jash.2014.09.020

Rates, amounts, and determinants of ambulatory blood pressure monitoring claim reimbursements among Medicare beneficiaries

J Am Soc Hypertens. 2014 Dec;8(12):898-908. doi: 10.1016/j.jash.2014.09.020. Epub 2014 Oct 2.

Authors

Shia T Kent¹, Daichi Shimbo², Lei Huang³, Keith M Diaz², Anthony J Viera⁴, Meredith Kilgore⁵, Suzanne Oparil⁶, Paul Muntner³

Affiliations

¹ Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA. Electronic address: shia@uab.edu.
² Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Medical Center, New York, NY, USA.
³ Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA.
⁴ Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
⁵ Department of Health Care Organization and Policy, University of Alabama at Birmingham, Birmingham, AL, USA.
⁶ Department of Medicine, Vascular Biology and Hypertension Program, University of Alabama at Birmingham, Birmingham, AL, USA.

Abstract

Ambulatory blood pressure monitoring (ABPM) can be used to identify white coat hypertension and guide hypertensive treatment. We determined the percentage of ABPM claims submitted between 2007 and 2010 that were reimbursed. Among 1970 Medicare beneficiaries with submitted claims, ABPM was reimbursed for 93.8% of claims that had an International Classification of Diseases, Ninth Revision, diagnosis code of 796.2 ("elevated blood pressure reading without diagnosis of hypertension") versus 28.5% of claims without this code. Among claims without an International Classification of Diseases, Ninth Revision, diagnosis code of 796.2 listed, those for the component (eg, recording, scanning analysis, physician review, reporting) versus full ABPM procedures and performed by institutional versus non-institutional providers were each more than two times as likely to be successfully reimbursed. Of the claims reimbursed, the median payment was $52.01 (25th-75th percentiles, $32.95-$64.98). In conclusion, educating providers on the ABPM claims reimbursement process and evaluation of Medicare reimbursement may increase the appropriate use of ABPM and improve patient care.

Keywords: Health services; health insurance reimbursement; medicare; white coat hypertension.

Publication types

Research Support, N.I.H., Extramural

MeSH terms

Aged
Aged, 80 and over
Blood Pressure Monitoring, Ambulatory / economics*
Female
Health Services Research
Humans
Insurance Claim Review
Male
Medicare / economics*
Reimbursement Mechanisms
United States
White Coat Hypertension / diagnosis*
White Coat Hypertension / economics

Abstract

Publication types

MeSH terms

Grants and funding