DR. RAYMOND SETH SOHN D.O
NPI 1033430640
Anesthesiology in Sheboygan, WI

Medicare Participation & PECOS Enrollment Status

Raymond Sohn is registered with Medicare and accepts claims assignment, this means the provider accepts the approved amount for the cost of rendered services as full payment. Participating providers may not charge beneficiaries more than the approved amount for their services. Please keep in mind that beneficiaries still have to pay a coinsurance or copayment amount for a visit or service.

Raymond Sohn is enrolled in PECOS and is eligible to order or refer health care services for Medicare patients. The provider is eligible to order or refer: Part B Clinical Laboratory and Imaging, Durable Medical Equipment (DME), a Home Health Agency (HHA) and Power Mobility Devices.

What is PECOS?
PECOS is the online Medicare enrollment management system or Provider, Enrollment, Chain and Ownership System. The PECOS system is a database of providers who have registered with CMS as providers or suppliers. PECOS is the primary source of information about verified Medicare professionals. Providers that want to participate in this program need to enroll in PECOS with their NPI number to avoid denied claims.

• Is the provider registered in PECOS? Yes

• PECOS PAC ID: 8426274754

  What is the PECOS Associate Control ID?
  A PAC ID is a unique 10-digit number assigned to an individual or organization healthcare provider in PECOS. The PAC ID is used to link together all the provider information, like tax identification numbers and organizational names. A PAC ID can be connected to multiple Enrollment IDs if an individual or organization has enrolled in PECOS more than once.

• PECOS Enrollment ID: I20180214003018

  What is the Provider Enrollment ID?
  The Enrollment ID is a unique alphanumeric 15-digit code assigned to each new provider's PECOS enrollment application. The Enrollment ID is used to link together all the provider enrollment information like enrollment type, state, provider specialty, and reassignment of benefits.

• Accepts Medicare Assignment? Yes

  What does it mean "accepts medicare assignment"?
  When a provider accepts Medicare assignment, the provider agrees to be paid directly by Medicare and to accept the payment amount approved by Medicare. Additionally, the provider agrees to not bill patients for more than the Medicare deductible and coinsurance amounts.
  A provider who doesn't accept assignment may charge you up to 15% over the Medicare-approved amount. This is known as the limiting charge. You may have to pay this amount, or it may be covered by another insurer.

• Eligible to Order or Refer Part B Clinical Laboratory and Imaging: Yes

• Eligible to Order or Refer Durable Medical Equipment (DMEPOS): Yes

• Eligible to Order or Refer a Home Health Agency (HHA): Yes

• Eligible to Order or Refer Power Mobility Devices: Yes

Areas of Expertise

The following services and procedures, recently provided to Medicare patients, illustrate the range of care this provider offers. This list reflects the variety of services available to all patients visiting the practice and is based on 2022 Medicare dataset. In general, the more frequently a provider treats specific conditions or performs particular procedures, the more experienced they become in addressing similar patient needs. The provider has delivered many of the services listed below to Medicare patients. Please note that this list does not include services provided to patients who are not covered by Medicare.

Aspiration and/or injection of fluid from large joint

This procedure involves using a needle to remove (aspiration) or introduce (injection) fluid into a large joint like the knee or hip. It can help diagnose conditions, relieve discomfort, or deliver medication directly to the joint.

This service was performed 19 times for 12 patients

Destruction of lower or sacral spinal facet joint nerves using imaging guidance, each additional facet joint

This procedure involves using imaging technology to locate and treat nerves in your lower spine or sacral area that may be causing pain. Each additional facet joint refers to treating more than one spinal nerve. It's a non-invasive way to manage chronic back pain.

This service was performed 30 times for 18 patients

Destruction of lower or sacral spinal facet joint nerves using imaging guidance, single facet joint

This procedure involves using imaging guidance to accurately target and destroy nerves in the lower or sacral spinal facet joint. It's done to relieve chronic back pain. The process is safe and usually effective.

This service was performed 26 times for 18 patients

Destruction of upper or middle spinal facet joint nerves using imaging guidance, each additional facet joint

This procedure involves the use of imaging technology to accurately target and destroy nerves in the upper or middle spinal facet joints, which may be causing pain. Each additional facet joint treated follows the same process.

This service was performed 22 times for 12 patients

Destruction of upper or middle spinal facet joint nerves using imaging guidance, single facet joint

This procedure involves the use of imaging technology to guide a needle to the nerves of a single facet joint in the upper or middle spine. The nerves are then treated to alleviate pain and improve mobility.

This service was performed 17 times for 12 patients

Electronic analysis reprogramming and refill of spinal canal drug infusion pump by physician

This procedure involves a physician checking and adjusting your spinal canal drug infusion pump. The pump's programming is updated electronically and the medication reservoir is refilled, ensuring effective pain management and optimal device performance.

This service was performed 15 times for 12 patients

Established patient office or other outpatient visit, 20-29 minutes

This is a routine visit for patients who have already been seen by the healthcare provider. During this approximately 20-29 minute appointment, your health status will be evaluated and any necessary treatments or tests will be discussed. It's a chance to address any health concerns you may have.

This service was performed 75 times for 68 patients

Established patient office or other outpatient visit, 30-39 minutes

This is a routine check-up for patients who have previously visited our clinic. It involves a comprehensive review of your health and any ongoing treatments. The consultation lasts between 30-39 minutes, allowing enough time to discuss any concerns.

This service was performed 42 times for 38 patients

Fluoroscopic guidance for needle placement

Fluoroscopic guidance for needle placement is a medical procedure that uses a special X-ray technology to help accurately place a needle in the body. It's often used in biopsies, injections or other treatments to ensure precision and safety.

This service was performed 28 times for 20 patients

Injection of anesthetic and/or steroid drug into sacral spine nerve root using imaging guidance, each additional level

This procedure involves injecting an anesthetic or steroid drug into the sacral spine nerve root. It's done under imaging guidance to ensure accuracy. The process can be repeated for each additional level of the spine to help manage pain or inflammation.

This service was performed 20 times for 16 patients

Injection of anesthetic and/or steroid drug into sacral spine nerve root using imaging guidance, single level

This procedure involves injecting a mix of numbing and anti-inflammatory medication into a specific nerve root in the lower back. It helps manage pain and reduce inflammation. The process is guided by imaging technology for precision.

This service was performed 54 times for 38 patients

Injection of anesthetic or steroid into joint between lower spine and hip bone using imaging guidance

This procedure involves injecting medicine into the joint where your lower spine meets your hip bone. Using special imaging technology, the doctor ensures the medicine is delivered accurately. This can help reduce pain and inflammation in that area.

This service was performed 36 times for 25 patients

Insertion of spinal neurostimulator electrode array through skin

This procedure involves placing a small device, called a neurostimulator electrode array, under your skin near your spine. It delivers mild electrical signals to your spinal cord, helping to manage chronic pain.

This service was performed 49 times for 18 patients

New patient office or other outpatient visit, 30-44 minutes

This service involves an initial office or outpatient visit for a new patient. The healthcare professional will spend 30-44 minutes understanding your health history, current issues, and discussing possible treatment plans. It's a comprehensive evaluation to start your healthcare journey.

This service was performed 23 times for 23 patients

New patient office or other outpatient visit, 45-59 minutes

This is a first-time office or outpatient visit lasting between 45-59 minutes. The healthcare provider evaluates your health, discusses your medical history, and may suggest further tests or treatments. It's an opportunity to ask questions and understand your health better.

This service was performed 19 times for 19 patients

Spinal fusion

Spinal fusion is a surgical procedure aimed at connecting two or more vertebrae in your spine to reduce pain and improve stability. It involves using a bone graft to cause the vertebrae to grow together, limiting the movement between them. This procedure is often performed to treat conditions like herniated discs or spinal stenosis.

This service was performed for 1-10 patients

Testing for presence of drug, by chemistry analyzers

Chemistry analyzers are used to detect the presence of drugs in your system. This test involves taking a small sample of your blood or urine. The sample is then analyzed for specific substances. The results help in understanding your health condition better.

This service was performed 39 times for 37 patients

Use of a drug to induce depression of consciousness by physician performing a procedure (5 years or older), initial 15 minutes

This procedure involves a doctor administering a medication to reduce your consciousness during a procedure. This helps in managing discomfort and anxiety. The initial application lasts for 15 minutes and is for individuals aged 5 years or older.

This service was performed 37 times for 32 patients

Overall MIPS Quality Performance

The provider participated in CMS Quality Payment Program under the Merit-based Incentive Payment System (MIPS) and has an overall final score of 97.32, based on four performance areas: quality, improvement activities, promoting interoperability, and cost. The purpose of this information is to help people with Medicare make informed decisions and incentivize doctors and clinicians to maximize performance.

The Merit-based Incentive Payment System (MIPS) is a way providers could use to participate in CMS Quality Payment Program (QPP). The MIPS program affects clinician reimbursement for Part B covered professional services and also rewards them for improving the quality of patient care and outcomes.

• Final Score: 97.32 out of 100

  The MIPS program evaluates providers across multiple categories with a specific weight for each category resulting a in a MIPS final score that ranges from 0 to 100 points. The MIPS Final Score determines whether providers receive a negative, neutral or positive MIPS payment adjustment.
  
  

• Quality Score: 88.78

  The Quality category assesses providers performance on clinical practices and patient outcomes under the traditional MIPS program. The quality measures help identify the quality of healthcare processes, outcomes, and patient experiences. The Quality measure category compromises 40% providers final MPIS scores.
  
  There are six collection types for MIPS quality measures: Electronic Clinical Quality Measures (eCQMs), MIPS Clinical Quality Measures (CQMs), Qualified Clinical Data Registry (QCDR) Measures, Medicare Part B claims measures, CMS Web Interface measures and The Consumer Assessment of Healthcare Providers and Systems (CAHPS) for MIPS Survey.
  
  

• Promoting Interoperability Score: N/A

  The Interoperability category measures the providers ability to use technology to exchange and make use of healthcare information in a way that is less burdensome and improves outcomes. The Interoperability measure category compromises 25% providers final MPIS scores.
  
  The MIPS Interoperability measure focuses on the use of certified electronic health record technology (CEHRT) to improve patient access health information, the exchange of information between clinicians and pharmacies and the systematic collection, analysis, and interpretation of healthcare data.

• Improvement Activities Score: 40

  The Improvement Activities performance category evaluates the providers participation in clinical activities that support the improvement of clinical practice, care delivery, and outcomes. Providers have the option to choose 2 to 4 activities from an inventory of over 100 improvement activities. Providers typically choose the activities that best fit their needs. The improvement activities measure category compromises 15% providers final MPIS scores.
  
  The Improvement measures aim to better patient engagement, patient safety and other areas of patient care. The Improvement Activities category compromises 15% of providers final MPIS scores.

• Cost Score: N/A

  The Cost performance category asses the amount and types of services provided and how clinicians coordinate care and seek improvement of health outcomes by ensuring patients receive the appropriate services.
  
  Although providers don't determine the price of healthcare services they are important in delivering high-quality care at a reasonable cost. The Cost measures category compromises 20% of providers final MPIS scores.

• Cost Score: N/A

  The Cost performance category asses the amount and types of services provided and how clinicians coordinate care and seek improvement of health outcomes by ensuring patients receive the appropriate services.
  
  Although providers don't determine the price of healthcare services they are important in delivering high-quality care at a reasonable cost. The Cost measures category compromises 20% of providers final MPIS scores.

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