SEARCH · PubMed Health
Results for “Fee Schedules”
Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
SNM and ACNP respond to Medicare fee schedule.
Explore the source record for details and available documents.
Specialty differentials, limited license practitioners, and Medicare's new fee schedule.
The use of specialty differentials in the newly adopted Medicare fee schedule has been debated over the past 2 years. Arguments supporting the elimination of specialty differentials for optometrists and ophthalmologists are presented. The first recommendations by the Physician Payment Review Commission eliminating specialty differentials represent a victory for optometry in its efforts to achieve parity in the reimbursement of Medicare-covered services. Relative value units and practice costs to be used by the new Medicare fee schedule must be determined for optometry. Estimates of the model fee schedules for eye care procedures have been released by the Department of Health and Human Services.
How the physician fee schedule affects Medicare patients' out-of-pocket spending.
Simulations of the redistributive effects of the new Medicare fee schedule have focused primarily on physicians, but patients may also be affected. Using a national sample of Medicare patients, we studied the fee schedule's potential impact on both components of out-of-pocket spending: copayments and balance bill amounts. While the fee schedule would raise copayments for the average patient, this effect would be more than offset by the balance billing limits (also imposed by Congress). Nevertheless, almost 10% of patients, particularly those who are black or living in rural areas, would experience large increases in their liability. Finally, the fee schedule with balance billing limits also serves as a "catastrophic coverage" program; patients with extraordinarily high medical expenses would enjoy substantial reductions in their out-of-pocket payments.
Understanding the Medicare Fee Schedule and its impact on physicians under the final rule.
On January 1, 1992, the Medicare program unveiled a new method for paying physicians known as the Medicare Fee Schedule (MFS). The new fee schedule is a complex system of administrative pricing based on the resource inputs used in producing physician services. The MFS consists of three parts: 1) a Relative Value Scale, which assigns to each medical service a value relative to all other services; 2) a conversion factor, which converts the relative values into dollars; and 3) a geographic adjustment factor, which adjusts payments based on geographic differences in the cost of producing physician services. In this article, the following are addressed: how the relative values were determined; how the geographic adjustment factor was constructed; and how the conversion factor was calculated. In addition, balance billing limits and the Medicare Volume Performance Standards (MVPS) are described. Computer simulations of the impact of the MFS on payments to physicians are presented. The authors found that the MFS will 1) redistribute payments away from surgeons, radiologists, and other procedure-based specialties toward the primary care specialties; 2) redistribute payments away from urban areas toward rural areas; and 3) redistribute payments away from invasive procedures and diagnostic tests toward evaluation and management services. The authors conclude with a discussion of the future refinements of the MFS, its applicability to other payers, and whether it will accomplish its intended purposes.
Has HCFA "broken faith" with its new physician fee schedule?
Physician groups are upset over the proposed new Medicare fee schedule. The RBRVS was to be budget-neutral and equitable; however, MD groups are charging that its implementation will be neither.
Understanding the new Medicare fee schedule.
The methodology for determining the Medicare allowance for physician services changed effective January 1, 1992. Prior to the new year, the allowance for most physician services was determined by the reasonable charge system; now, however, the Medicare allowance for most physician services is determined by the resource based relative value scale (RBRVS) fee schedule system. The RBRVS fee schedule is being phased in over a five-year transition period.
Developing physical therapy fee schedules based on Social Security Amendments of 1972.
Implications of the requirements related to the documentation and justification of the cost of physical therapy services are considered. These implications include 1) the cost components of physical therapy services, 2) the development of fee schedules, and 3) reimbursement requirements of third-party payers. The development of a fee schedule based on a sampling of the prevailing rates in two San Francisco Bay area counties is presented. The relationship between cost accounting, community standards, and the "prevailing rate" as defined by Medicare is documented. Public Law 92-603 and its ramifications for physical therapy fees and salaries are discussed.
Payment for diabetes care under the Medicare fee schedule.
The system Medicare uses to determine physician payment is inequitable to physicians who provide primarily evaluation and management (EM) services. This creates financial incentives that may discourage physicians from providing Medicare patients with care that meets the American Diabetes Association's standards. Under Medicare's resource-based fee schedule, which will be phased in beginning January 1992, payment for EM services should more accurately reflect the time, effort, and overhead costs involved in providing them. This article describes how physician payment will be determined under the Medicare fee schedule and examines the probable effects of changes in payment on the physicians who care for patients with diabetes and the quality of services they provide.
The new Medicare Fee Schedule.
Explore the source record for details and available documents.
Impact of the Medicare fee schedule on an academic department of medicine.
OBJECTIVE: To examine the effect of the Medicare Fee Schedule (MFS) on Medicare revenues in the department of medicine at an urban academic medical center after the MFS is fully implemented. METHODS: Department revenues from Medicare were compared with projected revenues using the MFS proposed by the Health Care Financing Administration on June 5, 1991. National Medicare claims data were used to determine differences in service mix between community and academic internists and the impact of the geographic component of the MFS on department revenues. RESULTS: Department revenues from Medicare in 1996 are projected to be 25.5% lower under the MFS than if the current system had continued. Subspecialty sections that perform large numbers of procedures and special tests had the largest decrease in revenues (eg, gastroenterology, -29.8%); however, this did not differ greatly from decreases in sections that mainly provide visits and consultations (eg, general internal medicine, -24.7%). CONCLUSION: The proposed MFS is projected to lead to substantial reductions in department revenues from Medicare. While relative values for services and geographic location will play a role in how individual departments fare under the MFS, the value of the conversion factor used in the final MFS will be the factor of greatest importance.
New fee schedule tests staff skills. The Health Care Group.
The Medicare Fee Schedule (MFS) picture is quite incomplete, with myriad details unsettled. But one thing is clear: the shift to a new reimbursement system is loaded with significant practice management implications and challenges. Now, before the MFS is implemented, physicians should evaluate their management operations and business systems, to meet the challenges ahead. Most physicians understand that practice viability will depend on increasing their patient base and the scope of services delivered to non-Medicare patients. Yet many do not understand the marketing and management challenges implied in such growth. The issues are these: how can a practice attract more non-Medicare patients? And how can such growth be accommodated without disproportionately increasing costs or inconveniencing patients and staff?
Updating the fee schedule for physician reimbursement: a comparative analysis of France, Germany, Canada, and the United States.
Based on an analysis of the fee schedule update process in France, the Federal Republic of Germany and Canada, this article draws a number of inferences and interpretations and concludes with a discussion of the major weaknesses and strengths of the United States.
Letter: Fee schedules and workloads.
Explore the source record for details and available documents.
J.J. Robinette advises new combines legislation unlikely to render dollar fee schedule illegal.
Explore the source record for details and available documents.