HEATHER C KOVICH, MD
NPI 1972615912, individual, Shiprock, NM, Family Medicine
- Medicaid dollars per patient on code 99213 ($467 per patient-month) sit in the top 5% of every provider billing that code.
National provider registry
From the CMS NPPES Registry, refreshed daily.
| Name | HEATHER C KOVICH, MD |
| Type | Individual |
| Status | Active |
| NPI issued | August 31, 2006, last updated April 6, 2021 |
| Practice location | US HIGHWAY 491 NORTH, Shiprock, NM 87420, 505-368-6001 |
| Mailing address | PO BOX 160, Shiprock, NM 87420-0160 |
| Specialties | Family Medicine (207Q00000X, primary, license 49599 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 | |
|---|---|---|---|---|---|---|---|
| 99213 | Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more | $689K | 97% | $467 | $44 (top 5% from $110) | 100th percentile | |
| 99212 | Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more | $21K | 3% | $437 | $28 (top 5% from $147) | too few months to rank | |
| 99214 | Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more | $3K | 0% | $14 | $60 (top 5% from $133) | 8th percentile |
| code | what it is | services | beneficiaries | paid | submitted per service | allowed per service | charge to allowed | usual for this code |
|---|---|---|---|---|---|---|---|---|
| 99214 | Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more | 148 | 83 | $10K | $180 | $93 | 1.9x | 2.3x (90th percentile 3.8x) |
| 99232 | Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes | 37 | 17 | $2K | $87 | $75 | 1.2x | 2.6x (90th percentile 4.3x) |
| 99238 | Hospital discharge day management, 30 minutes or less | 18 | 16 | $952 | $115 | $77 | 1.5x | 2.6x (90th percentile 4.7x) |
| 99213 | Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more | 19 | 17 | $906 | $117 | $63 | 1.8x | 2.2x (90th percentile 3.8x) |
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 San Juan County, NM carry an indicator in the public record, with $2.9M at stake between them. The most common is more hours than a day holds, on 2 of them.
| tier | provider | at stake | why |
|---|---|---|---|
| 4 | CHRISTOPHER PERCY Shiprock, NM, ranked 7661 | $2.2M |
|
| 4 | SARA MICHAELS Shiprock, NM, ranked 7898 | $689K |
|
Recent enforcement in NM
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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.