> Are you saying that Medicare/Medicaid reimbursement rates aren't public information?
Private insurer rates are definitely not public information, for any definition of "public".
Medicare reimbursement rates are sort of public, but not at the level of granularity you want. And a portion of that is because the question is not easily defined. For a given CPT code, Medicare might pay one of many different rates, depending on factors such as the geographic region, whether the provider operates in a CAH, whether the provider qualifies as a DSH, etc. That level of granularity is not easily accessible, and without it, there's no way to give meaningful example individual comparisons without running the risk of cherry-picking non-representative examples simply due to availability bias.
(Also, Medicare and Medicaid can't be lumped together. Medicare is a single, federal program that is administrated in four parts. Medicaid is a set of 50 different programs run at the state level, each of which can be administrated in more ways than I can count. The one thing that they all have in common here is that, like Medicare, they pay abysmal rates to providers, but the relationships that they have are even more complex - even in a single state, like New York, there are literally hundreds of different ways that Medicaid services can be provided, depending on the type of plan chosen.
Source: founded a company that had to abstract all of this complexity for patients, who were disproportionately on Medicare or Medicaid)
Yes, I'm willing to give up on the comparison to private insurance/transactions. So now I'm just wondering how to get a hold of Medicare reimbursement rates. We know that they vary by location, and other factors. But it must boil down somewhere, to a lookup table or a formula or the guy processing the forms who rolls a dice and multiplies by the last 3 digits of the medical code to come up with the reimbursement, etc.. Or is it all based on trust, and Medicare just pays 70% of any invoice that gets submitted to them? (And they send auditors out every once in a while in order to keep up appearances)
