MELANIE DOREEN HOFFMAN
NPI 1891286449, individual, Pueblo, CO, Psychologist
- Hours beyond a day in 1 month under one organization, which can be supervisory billing.
- Records needed.
- Medicaid dollars per patient on code 96137 ($775 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 |
|---|---|---|---|---|---|---|---|---|---|
| Feb 2024 | More hours than a day holds, even counting one unit per claim line | 51.6 | 11.6 | 7.7 | 10.7 | 264 | 2 | 90791 96132 96133 96136 96137 | $85K |
National provider registry
From the CMS NPPES Registry, refreshed daily.
| Name | MELANIE DOREEN HOFFMAN |
| Type | Individual |
| Status | Active |
| NPI issued | May 18, 2018, last updated May 18, 2018 |
| Practice location | 327 COLORADO AVE, Pueblo, CO 81004-2005, 719-948-7120 |
| Specialties | Psychologist (103T00000X, primary, license PSY.0004750 CO) |
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 | |
|---|---|---|---|---|---|---|---|
| 96133 | Evaluation of neuropsychological test, each additional hour | $531K | 38% | $775 | $238 (top 5% from $751) | 96th percentile | |
| 96137 | Administration of psychological or neuropsychological test, each additional 30 minutes | $394K | 28% | $505 | $116 (top 5% from $454) | 96th percentile | |
| 96132 | Evaluation of neuropsychological test, first hour | $156K | 11% | $220 | $92 (top 5% from $247) | 93rd percentile | |
| 90791 | Psychiatric diagnostic evaluation | $99K | 7% | $123 | $105 (top 5% from $228) | 69th percentile | |
| 90887 | Medicaid service code | $78K | 6% | $117 | $98 (top 5% from $270) | 60th percentile | |
| 96136 | Administration of psychological or neuropsychological test, first 30 minutes | $61K | 4% | $81 | $36 (top 5% from $90) | 94th percentile | |
| 96116 | Exam of neurobehavioral status, first hour | $22K | 2% | $137 | $59 (top 5% from $351) | 81st percentile | |
| 90837 | Psychotherapy, 1 hourhistory of abuse | $21K | 1% | $290 | $191 (top 5% from $442) | 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 |
|---|---|---|---|---|---|---|---|---|
| 96133 | Evaluation of neuropsychological test, each additional hour | 161 | 18 | $12K | $263 | $93 | 2.8x | 2.9x (90th percentile 5.2x) |
| 96137 | Administration of psychological or neuropsychological test, each additional 30 minutes | 237 | 18 | $7K | $100 | $36 | 2.7x | 3.2x (90th percentile 6.8x) |
| 96132 | Evaluation of neuropsychological test, first hour | 26 | 18 | $2K | $290 | $123 | 2.4x | 2.3x (90th percentile 4.7x) |
| 90791 | Psychiatric diagnostic evaluation | 17 | 17 | $2K | $250 | $163 | 1.5x | 1.9x (90th percentile 3.6x) |
| 96136 | Administration of psychological or neuropsychological test, first 30 minutes | 25 | 18 | $805 | $150 | $40 | 3.7x | 3.0x (90th percentile 6.1x) |
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
10 providers in Pueblo County, CO carry an indicator in the public record, with $6.8M at stake between them. The most common is part of a provider network, on 6 of them, followed by more hours than a day holds on 3.
| tier | provider | at stake | why |
|---|---|---|---|
| 3 | FRONTIER HOME HEALTH, LLC Pueblo, CO, ranked 1463 | $30K |
|
| 3 | COMFORT CARE FAMILY PRACTICE, INC. Pueblo, CO, ranked 1493 | $21K |
|
| 3 | MGA HOME HEALTHCARE PUEBLO, LLC Pueblo, CO, ranked 1587 | $5K |
|
| 3 | ALLELON OPCO OF COLORADO, LLC Pueblo, CO, ranked 2859 | $0 |
|
| 3 | CENTERCARE HOSPICE LLC Pueblo, CO, ranked 3642 | $0 |
|
| 3 | A BETTER COLORADO HOME HEALTH CARE AGENCY LLC Pueblo, CO, ranked 4564 | $0 |
|
| 3 | CENTER AT PARK WEST, LLC Pueblo, CO, ranked 6284 | $0 |
|
| 4 | MARIE CASTELLUCCI Pueblo, CO, ranked 7304 | $2.4M |
|
Recent enforcement in CO
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.