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Medicare

Also known as CMS, Medicare Part B, Original Medicare, Centers for Medicare and Medicaid Services.

Medicare is a government payer with a footprint nationwide as the federal benchmark every commercial contract is measured against. Medicare operates under parent company Centers for Medicare and Medicaid Services. For the providers who contract with it, the rates Medicare pays on high-volume procedures move the margin on every case.

DataLily Insights turns that footprint into answers. Rose, the AI analyst, reads more than 100 billion data points across over 10 million providers and explains in plain language how Medicare reimburses a given code in a given market. You can see where Medicare pays richer or leaner, how its allowed amounts compare to peer payers, and whether your contract is keeping pace.

Because Medicare anchors what every other payer is measured against, reading it precisely matters. DataLily Insights puts Medicare side by side with commercial rates for the same code and market, so you can see exactly how far your commercial contracts sit above or below the public benchmark.

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What Insights reveals

What DataLily Insights reveals about Medicare

Every benchmark below runs across more than 100 billion data points spanning over 10 million providers, so you see Medicare the way the market actually pays.

Negotiated and allowed rates by CPT and market

See what Medicare negotiates and allows for the CPT and HCPCS codes you bill, broken down by local market. Rose shows where Medicare sits richer or leaner on a procedure and how its allowed amounts move from one area to the next, so you can compare your contracted rates against the benchmark that actually matters.

Payer mix and share

Understand how much of your book runs through Medicare and how that share compares to other plans in your market. Rose maps Medicare's presence by specialty and geography so you can size what a Medicare contract is really worth to your practice.

Geographic and specialty strength

See the markets and procedure families where Medicare concentrates nationwide as the federal benchmark every commercial contract is measured against. Rose surfaces where Medicare runs strong and where it runs thin, so a contract conversation lands where it counts.

Are you underpaid versus peers

Put your own Medicare rates next to what comparable providers are paid for the same codes in the same market. If a gap exists on your high-volume procedures, DataLily Insights flags it and shows the size of the difference in dollars.

Ask Rose

Questions to ask Rose about Medicare

Rose answers in plain language, charts the result, and ends with a recommendation. Bring one of these to a demo.

“How does Medicare reimburse CPT 66984 (cataract surgery) in my market compared to other payers?”“Am I underpaid versus peers on my top procedures under Medicare?”“What is Medicare's payer mix and share for my specialty in this region?”“Where does Medicare pay richer or leaner across the markets I operate in?”“How do my contracted Medicare rates compare to the local benchmark for ophthalmology?”“Where is Medicare a dominant payer versus a minor one in my area?”

FAQ

Medicare reimbursement, answered

How does Medicare set rates?
Medicare pays on a published fee schedule that sets the floor much of the commercial market is measured against. DataLily Insights shows how your commercial contracts compare to the Medicare rate for the same code and market.
How can I tell if I am underpaid by Medicare versus my peers?
Rose compares your Medicare rates to what similar providers are paid for the same codes in the same market. If a gap exists on your high-volume procedures, DataLily Insights flags it and shows the size of the difference.
Does Medicare pay the same rates everywhere?
No. Medicare amounts shift by geography, specialty, and plan design, so a national average can be misleading. DataLily Insights breaks Medicare down to the CPT and market level for a precise view.
How much of my patient volume comes through Medicare?
That depends on your specialty and region, since Medicare's share varies across markets. DataLily Insights reveals Medicare's payer mix and share so you can gauge how much a Medicare relationship is worth to your practice.
Can DataLily Insights benchmark Medicare for my specialty?
Yes. Rose reads more than 100 billion data points across over 10 million providers and benchmarks Medicare for the exact codes and markets you work in, then ends with a plain-language read on where you stand.

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Bring your hardest question. We’ll answer it live.

Book twenty minutes and we’ll run it on your own market while you watch. You’ll leave with an answer you can use that afternoon.

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