ANDREW JEROME LANCIA, M.D.
NPI 1366647521, individual, Peoria, IL, Psychiatry & Neurology, Psychiatry
- Hours beyond a day in 1 month under one organization, which can be supervisory billing.
- Records needed.
- Medicaid dollars per patient on code 99239 ($178 per patient-month) sit in the top 5% of every provider billing that code.
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 |
|---|---|---|---|---|---|---|---|---|---|
| Oct 2019 | More hours than a day holds at a conservative unit price | 7.5 | 46.3 | 30.8 | 41.6 | 81 | 1 | 99223 99232 99239 | $41K |
National provider registry
From the CMS NPPES Registry, refreshed daily.
| Name | ANDREW JEROME LANCIA, M.D. |
| Type | Individual |
| Status | Active |
| NPI issued | June 18, 2007, last updated September 18, 2014 |
| Practice location | 900 MAIN ST STE 720, Peoria, IL 61602-5027, 309-495-1640 |
| Specialties | Psychiatry & Neurology, Psychiatry (2084P0800X, license R7853 IA) Psychiatry & Neurology, Psychiatry (2084P0800X, primary, license 036125088 IL) |
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 | |
|---|---|---|---|---|---|---|---|
| 99232 | Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes | $467K | 62% | $168 | $67 (top 5% from $174) | 94th percentile | |
| 99223 | Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes | $200K | 26% | $178 | $81 (top 5% from $170) | 96th percentile | |
| 99239 | Hospital discharge day management, more than 30 minutes | $74K | 10% | $120 | $49 (top 5% from $101) | 98th percentile | |
| 99254 | Medicaid service code | $18K | 2% | $96 | $90 (top 5% from $178) | 58th percentile |
| code | what it is | services | beneficiaries | paid | submitted per service | allowed per service | charge to allowed | usual for this code |
|---|---|---|---|---|---|---|---|---|
| 99232 | Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes | 301 | 97 | $18K | $157 | $77 | 2.1x | 2.6x (90th percentile 4.3x) |
| 99223 | Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes | 63 | 55 | $8K | $424 | $168 | 2.5x | 3.0x (90th percentile 5.6x) |
| 99233 | Subsequent hospital care with moderate levelof medical decision making, if using time, at least 50 minutes | 22 | 19 | $2K | $225 | $115 | 2.0x | 2.6x (90th percentile 4.7x) |
| 99222 | Initial hospital care with straightforward or low-level medical decision making, if using time, at least 55 minutes | 19 | 18 | $2K | $289 | $127 | 2.3x | 2.7x (90th percentile 4.4x) |
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
4 providers in Peoria County, IL carry an indicator in the public record, with $1.6M at stake between them. The most common is part of a provider network, on 3 of them, followed by more hours than a day holds on 1.
| tier | provider | at stake | why |
|---|---|---|---|
| 3 | COMFORT PLUS HOSPICE INC. Peoria, IL, ranked 3120 | $0 |
|
| 3 | SHARON HEALTH CARE ELMS, INC. Peoria, IL, ranked 4331 | $0 |
|
| 3 | IRIS HOME HEALTH SERVICES LLC Peoria, IL, ranked 5648 | $0 |
|
| 5 | LUKE XIE Peoria, IL, ranked 10876 | $1.6M |
Recent enforcement in IL
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.