ILEANA A. HELMS MD
NPI 1225039142
Internal Medicine - Nephrology in Concord, CA
About Ileana A. Helms Md NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
ILEANA A. HELMS MD (NPI 1225039142) is an individual nephrology provider in Concord, California, licensed in California (A48003) and active in the NPI registry since August 2005. She is enrolled in Medicare PECOS and is a graduate of Other (1981).
NPPES Registry Identity
Specialties & Licenses
An internist who treats disorders of the kidney, high blood pressure, fluid and mineral balance and dialysis of body wastes when the kidneys do not function. This specialist consults with surgeons about kidney transplantation.
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.
Medicare Enrollment Status
Enrolled in Medicare and accepts Medicare assignment
Ileana A. Helms Md is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.
Provider Referred Orders for Durable Medical Equipment, Devices & Supplies
The following list reflects the services, supplies or durable medical equipment ordered by this provider to a DME supplier on behalf of patients. The information below is derived from Medicare claims data and reflects the BETOS category, HCPCS code information and the number times each service was submitted under the Medicare fee-for-service program.
Unknown
Treatment-Treatment - Miscellaneous (RX029N)
Prednisone, immediate release or delayed release, oral, 1 mg (HCPCS:J7512)
4 DME suppliers used 12 Medicare Claims 1670 Services Paid
Treatment-Chemotherapy (RH012N)
Pharmacy supply fee for oral anti-cancer, oral anti-emetic or immunosuppressive drug(s); for a subsequent prescription in a 30-day period (HCPCS:Q0512)
4 DME suppliers used 13 Medicare Claims 15 Services Paid
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.
Critical care, first 30-74 minutes
Dialysis services, 1 physician visit per month (20 years or older)
Dialysis services, 2-3 physician visits per month (20 years or older)
Dialysis services, 4 or more physician visits per month (20 years or older)
Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more
Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes
Subsequent hospital care with moderate levelof medical decision making, if using time, at least 50 minutes
Telephone medical discussion with physician, 21-30 minutes
Critical care involves immediate and constant attention by a team of specially-trained health professionals. It's for patients with life-threatening conditions, requiring first 30-74 minutes of intense monitoring and treatment.
This service was performed 98 times for 26 patientsDialysis is a treatment that filters and purifies your blood using a machine. It helps keep your fluids and electrolytes in balance when the kidneys can’t do their job. A physician visit once a month ensures your treatment is working effectively and adjusts it if necessary. This service is available for individuals aged 20 years and older.
This service was performed 41 times for 34 patientsDialysis is a treatment that performs the function of healthy kidneys if they're not working properly. It removes waste and excess fluid from your blood. 2-3 physician visits per month are recommended for monitoring your health and adjusting your treatment as needed. This service is available for those aged 20 years and older.
This service was performed 242 times for 91 patientsDialysis is a treatment that filters and purifies your blood using a machine. It helps keep your fluids and electrolytes in balance when the kidneys can't do their job. This service includes 4 or more visits per month with a physician to monitor your health and adjust your treatment as needed.
This service was performed 613 times for 89 patientsThis 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 344 times for 181 patientsInitial hospital inpatient care per day, typically 70 minutes, refers to the daily medical service provided to patients admitted to the hospital. This includes a comprehensive evaluation, diagnosis, treatment plan, and monitoring of your health condition. It ensures your well-being during your hospital stay.
This service was performed 191 times for 100 patientsFollow-up hospital inpatient care per day typically involves a 35-minute check-up by your healthcare provider. This service includes monitoring your health progress, adjusting your treatment plan if needed, and answering any questions you may have about your condition or care.
This service was performed 851 times for 95 patientsThis service involves a 21-30 minute phone conversation with a physician. It's a chance for you to discuss your health concerns, symptoms or treatment plans. It's similar to an in-person consultation, but conducted over the phone for your convenience and safety.
This service was performed 180 times for 115 patientsPhysician Visit Costs
The typical physician office visit costs for Medicare beneficiaries in this area are: $38.45 for a new patient copayment and $29.87 for an established patient copayment.
The pricing information below displays the copayment minimum, maximum and average amount that patients under Medicare are charged when visiting this provider as a new or established patient. Please keep in mind that these prices are just for reference purposes, and the actual prices charged by the provider might be different.
For patients covered under private health plans the prices below are also useful as healthcare pricing for private insurance is usually established as a function of Medicare prices. Private insurance covered patients should check their individual plans to determine the exact pricing.
The prices below reflect the costs for new and established patients in the 94520 ZIP code area.
New Patients Visit Costs *
The most utilized procedure code for new patients office visits is 99204
- Average New Patient Price $153.83
- Minimum New Patient Price $69
- Maximum New Patient Price $202.35
- Average New Patient Copayment $38.45
- Minimum New Patient Copayment $17.25
- Maximum New Patient Copayment $50.58
Established Patients Visit Costs *
The most utilized procedure code for established patients office visits is 99214
- Average Established Patient Price $119.48
- Minimum Established Patient Price $23.44
- Maximum Established Patient Price $166.46
- Average Established Patient Copayment $29.87
- Minimum Established Patient Copayment $5.86
- Maximum Established Patient Copayment $41.61
* The physician office visit costs information is generated by statistical analysis of similar providers in the same geographical area. The pricing information above IS NOT the amount charged by this provider.
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 93.49, 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 provider also has detailed performance information the following quality measures: .
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.
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Final Score: 93.49 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.
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Quality Score: 81.74
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 comprises 40% of a provider's final MIPS score.
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.
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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 comprises 25% of a provider's final MIPS score.
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 comprises 15% of a provider's final MIPS score.
The Improvement measures aim to better patient engagement, patient safety and other areas of patient care. The Improvement Activities category comprises 15% of a provider's final MIPS score. -
Cost Score: 78.46
The Cost performance category assesses 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 comprises 20% of a provider's final MIPS score.
MIPS Quality Measures
The following performance measures were reported under the Merit-Based Incentive Payment System (MIPS) and Qualified Clinical Data Registry (QCDR) quality measures program.
| Quality Measure | Performance | Number of Patients |
|---|---|---|
| Breast Cancer Screening | 70% | 50 |
| Cervical Cancer Screening | 31% | 36 |
| Colorectal Cancer Screening | 57% | 124 |
| Controlling High Blood Pressure | 68% | 111 |
| Diabetes: Eye Exam | 31% | 68 |
| Diabetes: Hemoglobin A1c (HbA1c) Poor Control (>9%) | 31% "Inverse Quality Measure" This is an inverse quality measure, a lower rate means the provider is rated better. | 68 |
| Documentation of Current Medications in the Medical Record | 5% | 547 |
| Falls: Screening for Future Fall Risk | 47% | 167 |
| HIV Screening | 28% | 96 |
| Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan | 47% | 242 |
| Preventive Care and Screening: Screening for Depression and Follow-Up Plan | 42% | 177 |
| Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention | 90% | 176 |
| Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention | 93% | 176 |
| Statin Therapy for the Prevention and Treatment of Cardiovascular Disease | 87% | 149 |
Other Providers at the Same Location
The following 20 providers are registered at the same or a nearby location.
CONCORD, CA 94520
CONCORD, CA 94520
CONCORD, CA 94520
CONCORD, CA 94520
CONCORD, CA 94520
CONCORD, CA 94520
CONCORD, CA 94520
CONCORD, CA 94520
CONCORD, CA 94520
CONCORD, CA 94520
CONCORD, CA 94520
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1225039142, enumerated as an "individual" on August 02, 2005.
The provider is located at 2485 HIGH SCHOOL AVE SUITE 311 CONCORD, CA 94520 and the phone number is (925) 687-7272.
Internal Medicine with taxonomy code 207RN0300X and a focus in Nephrology.
