MRS. REBECCA SUE HAYWORTH M.D.
NPI 1699017731
Physical Medicine & Rehabilitation in Troy, OH

Medicare Participation & PECOS Enrollment Status

Rebecca Hayworth 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.

Rebecca Hayworth 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: 8325288301

  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: I20170511001806

  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.

Durable Medical Equipment

• DME-Oxygen and Supplies (DC002N)

  Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate (HCPCS:E1390)

  1 DME suppliers used 15 Medicare Claims 15 Services Paid

• DME-Wheelchairs (DD000N)

  Standard hemi (low seat) wheelchair (HCPCS:K0002)

  1 DME suppliers used 12 Medicare Claims 12 Services Paid

• DME-Wheelchairs (DD000N)

  Lightweight wheelchair (HCPCS:K0003)

  2 DME suppliers used 14 Medicare Claims 14 Services Paid

Orthotic Devices

• DME-Orthotic Devices (DF003N)

  Below knee, molded socket, shin, sach foot, endoskeletal system (HCPCS:L5301)

  16 DME suppliers used 44 Medicare Claims 45 Services Paid

• DME-Orthotic Devices (DF000N)

  Above knee, molded socket, open end, sach foot, endoskeletal system, single axis knee (HCPCS:L5321)

  14 DME suppliers used 27 Medicare Claims 27 Services Paid

• DME-Orthotic Devices (DF003N)

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

  18 DME suppliers used 78 Medicare Claims 126 Services Paid

• DME-Orthotic Devices (DF000N)

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

  17 DME suppliers used 54 Medicare Claims 99 Services Paid

• DME-Orthotic Devices (DF003N)

  Addition to lower extremity, below knee, acrylic socket (HCPCS:L5629)

  17 DME suppliers used 73 Medicare Claims 75 Services Paid

• DME-Orthotic Devices (DF000N)

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

  16 DME suppliers used 45 Medicare Claims 47 Services Paid

• DME-Orthotic Devices (DF003N)

  Addition to lower extremity, below knee, total contact (HCPCS:L5637)

  18 DME suppliers used 75 Medicare Claims 77 Services Paid

• DME-Orthotic Devices (DF003N)

  Addition to lower extremity, below knee, flexible inner socket, external frame (HCPCS:L5645)

  17 DME suppliers used 74 Medicare Claims 75 Services Paid

• DME-Orthotic Devices (DF003N)

  Addition to lower extremity, below knee suction socket (HCPCS:L5647)

  12 DME suppliers used 38 Medicare Claims 39 Services Paid

• DME-Orthotic Devices (DF000N)

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

  17 DME suppliers used 47 Medicare Claims 48 Services Paid

• DME-Orthotic Devices (DF000N)

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

  17 DME suppliers used 50 Medicare Claims 51 Services Paid

• DME-Orthotic Devices (DF000N)

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

  16 DME suppliers used 45 Medicare Claims 47 Services Paid

• DME-Orthotic Devices (DF000N)

  Addition to lower extremity, suction suspension, above knee or knee disarticulation socket (HCPCS:L5652)

  9 DME suppliers used 15 Medicare Claims 15 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)

  20 DME suppliers used 68 Medicare Claims 70 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)

  20 DME suppliers used 74 Medicare Claims 154 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)

  16 DME suppliers used 61 Medicare Claims 119 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)

  15 DME suppliers used 51 Medicare Claims 103 Services Paid

• DME-Orthotic Devices (DF003N)

  Replacement, socket, below knee, molded to patient model (HCPCS:L5700)

  14 DME suppliers used 29 Medicare Claims 31 Services Paid

• DME-Orthotic Devices (DF000N)

  Replacement, socket, above knee/knee disarticulation, including attachment plate, molded to patient model (HCPCS:L5701)

  9 DME suppliers used 18 Medicare Claims 18 Services Paid

• DME-Orthotic Devices (DF000N)

  Addition to lower limb prosthesis, vacuum pump, residual limb volume management and moisture evacuation system (HCPCS:L5781)

  8 DME suppliers used 14 Medicare Claims 14 Services Paid

• DME-Orthotic Devices (DF003N)

  Addition, endoskeletal knee-shin system, single axis, fluid swing and stance phase control (HCPCS:L5828)

  13 DME suppliers used 22 Medicare Claims 22 Services Paid

• DME-Orthotic Devices (DF003N)

  Addition, endoskeletal, knee-shin system, stance flexion feature, adjustable (HCPCS:L5845)

  14 DME suppliers used 28 Medicare Claims 28 Services Paid

• DME-Orthotic Devices (DF003N)

  Addition to endoskeletal knee-shin system, fluid stance extension, dampening feature, with or without adjustability (HCPCS:L5848)

  13 DME suppliers used 21 Medicare Claims 21 Services Paid

• DME-Orthotic Devices (DF000N)

  Addition, endoskeletal system, above knee or hip disarticulation, knee extension assist (HCPCS:L5850)

  8 DME suppliers used 12 Medicare Claims 12 Services Paid

• DME-Orthotic Devices (DF003N)

  Addition to lower extremity prosthesis, endoskeletal knee-shin system, microprocessor control feature, swing and stance phase, includes electronic sensor(s), any type (HCPCS:L5856)

  13 DME suppliers used 19 Medicare Claims 19 Services Paid

• DME-Orthotic Devices (DF003N)

  Addition, endoskeletal system, below knee, alignable system (HCPCS:L5910)

  17 DME suppliers used 64 Medicare Claims 64 Services Paid

• DME-Orthotic Devices (DF000N)

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

  16 DME suppliers used 41 Medicare Claims 41 Services Paid

• DME-Orthotic Devices (DF000N)

  Addition, endoskeletal system, above knee, knee disarticulation or hip disarticulation, manual lock (HCPCS:L5925)

  8 DME suppliers used 12 Medicare Claims 12 Services Paid

• DME-Orthotic Devices (DF003N)

  Addition, endoskeletal system, below knee, ultra-light material (titanium, carbon fiber or equal) (HCPCS:L5940)

  17 DME suppliers used 70 Medicare Claims 72 Services Paid

• DME-Orthotic Devices (DF000N)

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

  16 DME suppliers used 39 Medicare Claims 40 Services Paid

• DME-Orthotic Devices (DF003N)

  Addition to lower limb prosthesis, multiaxial ankle with swing phase active dorsiflexion feature (HCPCS:L5968)

  12 DME suppliers used 21 Medicare Claims 21 Services Paid

• DME-Orthotic Devices (DF003N)

  All lower extremity prostheses, foot, flexible keel (HCPCS:L5972)

  12 DME suppliers used 26 Medicare Claims 27 Services Paid

• DME-Orthotic Devices (DF003N)

  All lower extremity prostheses, flex-walk system or equal (HCPCS:L5981)

  18 DME suppliers used 38 Medicare Claims 38 Services Paid

• DME-Orthotic Devices (DF000N)

  All endoskeletal lower extremity prosthesis, axial rotation unit, with or without adjustability (HCPCS:L5984)

  7 DME suppliers used 12 Medicare Claims 12 Services Paid

• DME-Orthotic Devices (DF000N)

  All lower extremity prostheses, multi-axial rotation unit ('mcp' or equal) (HCPCS:L5986)

  12 DME suppliers used 22 Medicare Claims 23 Services Paid

• DME-Orthotic Devices (DF000N)

  Prosthetic sheath, below knee, each (HCPCS:L8400)

  11 DME suppliers used 46 Medicare Claims 331 Services Paid

• DME-Orthotic Devices (DF003N)

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

  18 DME suppliers used 77 Medicare Claims 543 Services Paid

• DME-Orthotic Devices (DF000N)

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

  16 DME suppliers used 46 Medicare Claims 298 Services Paid

• DME-Orthotic Devices (DF000N)

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

  15 DME suppliers used 42 Medicare Claims 79 Services Paid

• DME-Orthotic Devices (DF000N)

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

  12 DME suppliers used 29 Medicare Claims 56 Services Paid

• DME-Orthotic Devices (DF000N)

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

  16 DME suppliers used 68 Medicare Claims 398 Services Paid

• DME-Orthotic Devices (DF000N)

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

  15 DME suppliers used 36 Medicare Claims 220 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 76 times for 57 patients

Follow-up hospital inpatient care per day, typically 25 minutes

Follow-up hospital inpatient care involves daily check-ups while you're admitted in the hospital. Typically, a healthcare provider spends about 25 minutes each day reviewing your condition, adjusting treatment if needed, and answering any questions you might have.

This service was performed 188 times for 57 patients

Hospital discharge day management, 30 minutes or less

Hospital discharge day management of 30 minutes or less includes finalizing your treatment, discussing your progress, and planning after-care at home. It ensures you're ready to leave the hospital and continue recovery safely.

This service was performed 35 times for 35 patients

Initial hospital inpatient care per day, typically 50 minutes

Initial hospital inpatient care is a service where a healthcare provider spends about 50 minutes per day overseeing your care while you're admitted in the hospital. This includes reviewing your health status, planning your treatment, and ensuring your safety and comfort.

This service was performed 37 times for 37 patients

Needle measurement of electrical activity in arm or leg muscles, complete study

This procedure, known as an electromyography (EMG), involves inserting a small needle into your arm or leg muscles to measure their electrical activity. This complete study helps diagnose issues with nerves or muscles, providing valuable data for your treatment plan.

This service was performed 92 times for 58 patients

Nerve conduction, 5-6 studies

Nerve conduction studies involve testing the speed and strength of signals traveling through your nerves. This helps identify any nerve damage or dysfunction. For 5-6 studies, this means multiple nerves will be tested. Small electrodes are placed on your skin to send and receive signals, causing minimal discomfort.

This service was performed 31 times for 31 patients

Nerve conduction, 9-10 studies

Nerve conduction studies involve sending small electrical shocks through the skin to measure how quickly nerves transmit signals. This helps detect nerve damage. 9-10 studies mean this process will be repeated on different nerves to gather comprehensive data.

This service was performed 12 times for 12 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 119 times for 119 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 78, 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: 78 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: 72.24

  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: 96

  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: 20

  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.

Quality Reporting

The provider participated in CMS Quality Payment Program. The Quality Payment Program aims to improve population health, reduce costs and improve the care received by Medicare beneficiaries. The following quality measures meet Medicare's statistical reporting standards. Not all providers report the same information, because not all providers give the same services to patients. The quality information is just a snapshot of some the care providers give to their patients. Reporting more or less information is not a reflection of quality.

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. Rebecca Hayworth is affiliated with the following medical facilities:

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