NORMAN A ALIGA MD
NPI 1548335524
Physical Medicine & Rehabilitation in Wheaton, IL

Medicare Participation & PECOS Enrollment Status

Norman Aliga 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.

Norman Aliga 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: 2163561267

  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: I20091203000122

  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

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.

Orthotic Devices

• DME-Orthotic Devices (DF003N)

  Ankle foot orthosis, spiral, (institute of rehabilitative medicine type), plastic or other material, prefabricated, includes fitting and adjustment (HCPCS:L1951)

  1 DME suppliers used 12 Medicare Claims 13 Services Paid

• DME-Orthotic Devices (DF003N)

  Ankle foot orthosis, posterior solid ankle, plastic, custom fabricated (HCPCS:L1960)

  1 DME suppliers used 17 Medicare Claims 20 Services Paid

• DME-Orthotic Devices (DF000N)

  Addition to lower extremity, varus/valgus correction, plastic modification, padded/lined (HCPCS:L2275)

  1 DME suppliers used 25 Medicare Claims 28 Services Paid

• DME-Orthotic Devices (DF000N)

  Addition to lower extremity orthosis, soft interface for molded plastic, below knee section (HCPCS:L2820)

  1 DME suppliers used 30 Medicare Claims 34 Services Paid

• DME-Orthotic Devices (DF000N)

  Wrist hand finger orthosis, without joint(s), prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise (HCPCS:L3807)

  1 DME suppliers used 13 Medicare Claims 14 Services Paid

• DME-Orthotic Devices (DF003N)

  Addition to lower extremity, test socket, below knee (HCPCS:L5620)

  3 DME suppliers used 11 Medicare Claims 16 Services Paid

• DME-Orthotic Devices (DF000N)

  Addition to lower extremity, test socket, above knee (HCPCS:L5624)

  4 DME suppliers used 11 Medicare Claims 16 Services Paid

• DME-Orthotic Devices (DF000N)

  Addition to lower extremity, above knee or knee disarticulation, acrylic socket (HCPCS:L5631)

  4 DME suppliers used 11 Medicare Claims 11 Services Paid

• DME-Orthotic Devices (DF000N)

  Addition to lower extremity, ischial containment/narrow m-l socket (HCPCS:L5649)

  4 DME suppliers used 11 Medicare Claims 11 Services Paid

• DME-Orthotic Devices (DF000N)

  Additions to lower extremity, total contact, above knee or knee disarticulation socket (HCPCS:L5650)

  4 DME suppliers used 11 Medicare Claims 11 Services Paid

• DME-Orthotic Devices (DF000N)

  Addition to lower extremity, above knee, flexible inner socket, external frame (HCPCS:L5651)

  4 DME suppliers used 11 Medicare Claims 11 Services Paid

• DME-Orthotic Devices (DF003N)

  Addition to lower extremity, below knee / above knee suspension locking mechanism (shuttle, lanyard or equal), excludes socket insert (HCPCS:L5671)

  4 DME suppliers used 11 Medicare Claims 11 Services Paid

• DME-Orthotic Devices (DF003N)

  Addition to lower extremity, below knee/above knee, custom fabricated from existing mold or prefabricated, socket insert, silicone gel, elastomeric or equal, for use with locking mechanism (HCPCS:L5673)

  4 DME suppliers used 15 Medicare Claims 28 Services Paid

• DME-Orthotic Devices (DF003N)

  Addition to lower extremity, below knee/above knee, custom fabricated from existing mold or prefabricated, socket insert, silicone gel, elastomeric or equal, not for use with locking mechanism (HCPCS:L5679)

  3 DME suppliers used 11 Medicare Claims 21 Services Paid

• DME-Orthotic Devices (DF003N)

  Addition to lower extremity prosthesis, below knee, suspension/sealing sleeve, with or without valve, any material, each (HCPCS:L5685)

  3 DME suppliers used 18 Medicare Claims 31 Services Paid

• DME-Orthotic Devices (DF000N)

  Addition, endoskeletal system, above knee or hip disarticulation, alignable system (HCPCS:L5920)

  4 DME suppliers used 11 Medicare Claims 11 Services Paid

• DME-Orthotic Devices (DF000N)

  Addition, endoskeletal system, above knee, ultra-light material (titanium, carbon fiber or equal) (HCPCS:L5950)

  4 DME suppliers used 11 Medicare Claims 11 Services Paid

• DME-Orthotic Devices (DF003N)

  Prosthetic sock, multiple ply, below knee, each (HCPCS:L8420)

  3 DME suppliers used 15 Medicare Claims 91 Services Paid

• DME-Orthotic Devices (DF000N)

  Prosthetic sock, multiple ply, above knee, each (HCPCS:L8430)

  4 DME suppliers used 13 Medicare Claims 78 Services Paid

• DME-Orthotic Devices (DF000N)

  Prosthetic shrinker, below knee, each (HCPCS:L8440)

  3 DME suppliers used 20 Medicare Claims 40 Services Paid

• DME-Orthotic Devices (DF000N)

  Prosthetic shrinker, above knee, each (HCPCS:L8460)

  2 DME suppliers used 20 Medicare Claims 42 Services Paid

• DME-Orthotic Devices (DF000N)

  Prosthetic sock, single ply, fitting, below knee, each (HCPCS:L8470)

  3 DME suppliers used 13 Medicare Claims 79 Services Paid

• DME-Orthotic Devices (DF000N)

  Prosthetic sock, single ply, fitting, above knee, each (HCPCS:L8480)

  3 DME suppliers used 13 Medicare Claims 78 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.

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 143 times for 109 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 258 times for 154 patients

Established patient office or other outpatient visit, 40-54 minutes

This service involves a follow-up appointment for existing patients, lasting between 40 to 54 minutes. During this time, your healthcare provider will assess your current health status, discuss any changes or concerns, review your treatment plan, and answer any questions you may have.

This service was performed 31 times for 28 patients

Imaging for evaluation of swallowing function

This process, known as a swallowing study, uses imaging technology to view how food and liquid move from your mouth to your stomach. It helps identify any issues you may have swallowing, which can be crucial for determining the best treatment plan.

This service was performed 154 times for 132 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 33 times for 33 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 27 times for 27 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 94.1, 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: 94.1 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: 82.59

  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: 100

  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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