CAROL L SHIELDS MD
NPI 1578652988
Ophthalmology in Philadelphia, PA

Medicare Participation & PECOS Enrollment Status

Carol Shields 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.

Carol Shields 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: 3678568987

  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: I20040416000732, I20211217000100

  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 (DF000N)

  Prosthetic eye, plastic, custom (HCPCS:V2623)

  5 DME suppliers used 11 Medicare Claims 11 Services Paid

Unknown

• Other-Vision, Hearing, and Speech Services (OC000N)

  Polishing/resurfacing of ocular prosthesis (HCPCS:V2624)

  7 DME suppliers used 33 Medicare Claims 34 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.

1d and 2d ultrasound scan of eye tissue and structures

A 1D and 2D ultrasound scan of the eye is a non-invasive process that uses sound waves to create images of the eye's inner structures. This helps in detecting abnormalities or issues in the eye tissue. The procedure is safe, quick, and painless.

This service was performed 945 times for 726 patients

Destruction of growth of cornea

Destruction of growth on the cornea is a procedure where unwanted or abnormal tissue on the cornea, the clear front surface of the eye, is removed. This can improve vision and eye health. The procedure may involve laser technology or surgical removal, depending on the size and type of the growth.

This service was performed 22 times for 22 patients

Destruction of growth of retina by implantation of radiation source

This procedure involves placing a radiation source near the retina, the back part of your eye, to destroy abnormal growth. The radiation helps control the growth's size and prevent it from causing further damage to your vision.

This service was performed 56 times for 56 patients

Destruction of growth of retina using a laser

This procedure involves using a precise laser to target and remove abnormal growths on the retina, the thin layer at the back of the eye. It's a safe and effective way to protect your vision and prevent further eye damage.

This service was performed 39 times for 38 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 813 times for 721 patients

Exam of retinal blood vessels and blood vessels between the white part of eye and retina using a special camera after injection of a dye

This procedure involves a special camera capturing images of the eye's blood vessels. A dye is injected into your body, which travels to the eye's vessels, highlighting them in the photos. This helps identify any abnormalities in the retina and surrounding areas.

This service was performed 74 times for 73 patients

Exam of the internal drainage system of eye

This is a procedure where your doctor examines the eye's internal drainage system, essential for maintaining eye pressure. They use specialized tools to check for blockages or damage that might lead to conditions like glaucoma. It's non-invasive and painless.

This service was performed 51 times for 47 patients

Exam of visual field with extended testing

An extended visual field exam is a detailed test to evaluate your peripheral (side) vision. It helps to detect any potential blind spots which may not be noticeable in daily life. These could be caused by eye diseases like glaucoma, or neurological conditions.

This service was performed 127 times for 125 patients

Exploration of cavity behind eye

Exploration of the cavity behind the eye is a procedure where doctors examine the area at the back of your eye. It's conducted to identify any potential issues like infections, tumors, or injuries. This procedure helps ensure your eye health and overall well-being.

This service was performed 15 times for 15 patients

Extended exam of the back part of the eye with retinal drawing

This procedure involves a detailed examination of the back part of your eye, including the retina. It helps identify any abnormalities or issues. A retinal drawing is made to record findings. It's non-invasive and crucial for maintaining eye health.

This service was performed 74 times for 70 patients

Extensive removal of growth of face or scalp, less than 2.0 cm

This procedure involves the careful removal of a growth on the face or scalp that is under 2.0 cm in size. It's typically performed under local anesthesia, ensuring minimal discomfort. The goal is to eliminate the growth while preserving surrounding healthy tissue.

This service was performed 32 times for 32 patients

Fine needle aspiration of orbital contents

Fine needle aspiration of orbital contents is a medical procedure where a thin needle is used to collect samples from your eye area (orbit). It helps diagnose conditions like tumors or infections. You might feel slight discomfort, but it's generally safe.

This service was performed 45 times for 45 patients

Imaging of front third of eye

Imaging of the front third of the eye, also known as anterior segment imaging, captures detailed images of the eye's front part. This includes the iris, cornea, and lens. It's a non-invasive procedure that helps diagnose and monitor eye conditions.

This service was performed 206 times for 176 patients

Imaging of retina

Imaging of the retina is a non-invasive procedure that captures detailed images of your eye's interior. This helps detect conditions like macular degeneration or retinal detachment. It's painless and takes only a few minutes.

This service was performed 1,121 times for 943 patients

Melanoma (skin cancer) excision

Melanoma excision is a procedure where a surgeon removes melanoma, a type of skin cancer, and some surrounding healthy tissue. Local anesthesia is applied to numb the area. The goal is to completely remove the cancer and prevent its spread. Healing time varies.

This service was performed for 1-10 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 387 times for 387 patients

Online digital evaluation and management service for an established patient for up to 7 days, total time 5-10 minutes

This service involves a week-long digital assessment of your health status. It's conducted online by your healthcare provider, focusing on managing your existing health condition. The process takes 5-10 minutes of your time daily, ensuring optimal health management.

This service was performed 16 times for 16 patients

Photography of content of eyes

Photography of the content of eyes, also known as ocular photography, captures detailed images of different parts of the eye. It helps identify and monitor conditions like glaucoma, macular degeneration, or diabetic retinopathy. The process is non-invasive and painless.

This service was performed 314 times for 267 patients

Photography of the retina

Photography of the retina, also known as retinal imaging, is a non-invasive procedure that captures images of the back of your eye. This helps doctors identify and monitor conditions like glaucoma, macular degeneration, or diabetic retinopathy. It's painless and quick, often part of a routine eye exam.

This service was performed 1,120 times for 943 patients

Realignment of vertical eye muscle

Realignment of vertical eye muscle is a surgical procedure aimed to correct problems with eye movement or alignment. This involves adjusting the length or position of eye muscles, helping your eyes to focus together properly. It's a common solution for conditions like strabismus (crossed eyes).

This service was performed 11 times for 11 patients

Release of extensive scar tissue of eye

This procedure involves the removal of extensive scar tissue from the eye. Scar tissue can affect vision by blocking or distorting light. The operation uses specialized tools to carefully remove the scar tissue, aiming to restore or improve your sight.

This service was performed 16 times for 16 patients

Removal of growth of cornea

The removal of a corneal growth is a procedure to eliminate abnormal tissue from the cornea, the clear front surface of the eye. This can help improve vision and alleviate discomfort. The process is typically performed by an ophthalmologist under local anesthesia.

This service was performed 20 times for 20 patients

Removal of growth of sclera

Removal of a growth on the sclera involves a surgical procedure to eliminate an abnormal tissue or lesion from the white part of your eye. This is done to prevent potential vision problems and enhance eye health. Rest assured, your comfort and safety are prioritized.

This service was performed 22 times for 22 patients

Repair of eyelid lining with graft from external eye

This procedure involves fixing the inner lining of your eyelid. A graft, or a piece of tissue, from the external part of your eye is used for repair. It helps restore normal eyelid function and appearance.

This service was performed 83 times for 83 patients

Repair of lacerated cornea and/or sclera using tissue glue

This procedure involves mending a tear in your cornea or sclera (the white part of your eye) using a special tissue glue. It's a way to promote healing, prevent infection, and restore your eye's structure and function.

This service was performed 83 times for 83 patients

Temporary closure of eyelids by suture

Temporary closure of eyelids by suture is a medical procedure to protect the eye. It involves stitching the eyelids together to prevent them from opening, often due to injury or disease. This helps to heal the eye by reducing exposure and irritation.

This service was performed 60 times for 60 patients

Ultrasound scan of eye using water bath method

An ultrasound scan of the eye using the water bath method is a non-invasive procedure. It involves placing the eye in a small container of water to create clear images of the eye's internal structures. This assists in diagnosing and monitoring various eye conditions.

This service was performed 129 times for 117 patients

Physician Visit Costs

The typical physician office visit costs for Medicare beneficiaries in this area are: $34.29 for a new patient copayment and $18.61 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 19107 ZIP code area.

* 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 71.53, 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.

• Final Score: 71.53 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: 52.61

  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.
  
  

• Promoting Interoperability Score: 92

  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: N/A

  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

Find Provider Hospital Affiliations - Privileges

Doctors and physicians must apply for hospital privileges to treat patients at hospitals. Find out if your doctor has privileges to practice at your preferred hospital by using the hospital affiliation information below based on recent medical claims.

Hospital affiliation is identified through self-reporting data, inpatient, outpatient, physician and ancillary service claims linked by the medical claims NPI number and place of service code. Additionally, to further determine provider hospital affiliation the clinician must have provided services to at least three patients on three different dates in the last 12 months. Carol Shields is affiliated with the following medical facilities:

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