MILTON D SHAW, M.D.
NPI 1346203007, individual, Boerne, TX, Internal Medicine
- Hours beyond a day in 1 month, but with up to 143 patients a month, which points to a supervising clinician on the claims rather than one person's hours.
- Records needed.
Hours billed per day
Medicaid billing converted into hours of hands-on care per day. The lower bound counts one unit per claim line and needs no price; the other two divide dollars by a unit price, the conservative one at 1.5 times the price. The clinician on the claim may be a supervisor under state rules, so billing organizations are counted too.
| month | what was found | hours per day, lower bound | hours per day, at price | hours per day, conservative | per working day | patients | billing organizations | codes | paid |
|---|---|---|---|---|---|---|---|---|---|
| Jan 2018 | More hours than a day holds at a conservative unit price | 3.1 | 39.0 | 26.0 | 35.0 | 106 | 1 | 99306 99310 | $8K |
National provider registry
From the CMS NPPES Registry, refreshed daily.
| Name | MILTON D SHAW, M.D. |
| Type | Individual |
| Status | Active |
| NPI issued | April 11, 2006, last updated July 20, 2023 |
| Practice location | 113 PLEASANT VALLEY DR, SUITE 210, Boerne, TX 78006-5683, 830-267-4575 |
| Specialties | Internal Medicine (207R00000X, primary, license F1998 TX) |
Procedures billed
The specific codes behind the dollars. Medicaid figures come from T-MSIS (2018 to 2024) and are compared with every other provider billing the same code; Medicare figures come from the 2024 physician and supplier file and compare this provider's submitted charge with what Medicare allowed, against the usual ratio for that code.
| code | what it is | paid | share | per patient-month | typical | rank among providers | |
|---|---|---|---|---|---|---|---|
| T2046 | Medicaid service code | $436K | 86% | $4K | $4K (top 5% from $6K) | 38th percentile | |
| 99310 | Subsequent nursing facility care with high level of medical decision making, per day, if using time, at least 45 minutes | $39K | 8% | $12 | $30 (top 5% from $134) | 19th percentile | |
| 99309 | Subsequent nursing facility care with moderate level of medical decision making, per day, if using time, at least 30 minutes | $26K | 5% | $13 | $21 (top 5% from $84) | 31st percentile | |
| 99306 | Initial nursing facility care with high level of medical decision making, per day, if using time, 50 minutes or more | $4K | 1% | $17 | $37 (top 5% from $100) | 17th percentile | |
| G0439 | Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit | $0 | 0% | $0.00 | $0.51 (top 5% from $73) | too few months to rank | |
| 36415 | Insertion of needle into vein for collection of blood sample | $0 | 0% | $0.00 | $1.97 (top 5% from $12) | too few months to rank | |
| 99318 | Medicaid service code | $0 | 0% | $0.00 | $18 (top 5% from $58) | too few months to rank | |
| G0438 | Annual wellness visit; includes a personalized prevention plan of service (pps), initial visit | $0 | 0% | $0.00 | $0.48 (top 5% from $132) | too few months to rank |
| code | what it is | services | beneficiaries | paid | submitted per service | allowed per service | charge to allowed | usual for this code |
|---|---|---|---|---|---|---|---|---|
| 99350 | Residence visit for established patient with high level of medical decision making, per day, if using time, at least 60 minutes | 171 | 163 | $24K | $273 | $177 | 1.5x | 1.9x (90th percentile 3.3x) |
| 99310 | Subsequent nursing facility care with high level of medical decision making, per day, if using time, at least 45 minutes | 202 | 149 | $19K | $183 | $146 | 1.3x | 2.0x (90th percentile 3.4x) |
| 99306 | Initial nursing facility care with high level of medical decision making, per day, if using time, 50 minutes or more | 75 | 72 | $10K | $236 | $173 | 1.4x | 1.9x (90th percentile 3.1x) |
| 99349 | Residence visit for established patient with moderate level of medical decision making, per day, if using time, at least 40 minutes | 97 | 90 | $9K | $202 | $122 | 1.7x | 2.0x (90th percentile 3.4x) |
| 99309 | Subsequent nursing facility care with moderate level of medical decision making, per day, if using time, at least 30 minutes | 50 | 32 | $3K | $126 | $102 | 1.2x | 2.0x (90th percentile 3.3x) |
A submitted charge many times the allowed amount is common and lawful; it matters when it is far above what other providers submit for the same code.
In this area
2 providers in Kendall County, TX carry an indicator in the public record, with $29K at stake between them. The most common is part of a provider network, on 1 of them, followed by more hours than a day holds on 1.
| tier | provider | at stake | why |
|---|---|---|---|
| 3 | SUNRISE PRIMARY CARE SERVICES INC Boerne, TX, ranked 2800 | $0 |
|
| 4 | PETER ACOSTA Boerne, TX, ranked 9685 | $29K |
|
Recent enforcement in TX
All releasesDepartment of Justice and HHS-OIG releases for this state, newest first. Each opens in a new tab.
Referral packet
The packet is a draft for a reviewer. It reads every public record behind this case, states what the records show with a citation for each finding, names the regulation each finding relates to, and lists the ordinary explanations to rule out first. It never asserts intent.