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At the dawn of civilization, about 4,000 years ago, a massive pillar of stone and written clay tablets already prescribed the concepts of managed care for the practice of medicine. Codex Hammurabi established a sliding fee schedule for services, promoted outcome measurements, which if not met, resulted in harsh penalties, required medical records to document diseases and therapies, included prescription benefits, fully explained patient's rights, and marketing and advertising publicized the edicts of the King. Even though the managed care was authoritarian, there were legal actions to insure justice and equity particular to each social class in the kingdom. Tempered by time, the managed care mandates of Codex Hammurabi can still be considered the genesis of the current concepts of managed care.

Fee Schedules↗

PubMed1997

Medicare's resource-based relative value scale, a de facto national fee schedule: its implications and uses for neurologists.

The institution of the RBRVS as a basis of Medicare reimbursement corrects some long-standing inequities. First, it corrects the magnitude of reimbursement of procedures compared with cognitive services. Second, it corrects unexplained geographical variations in reimbursement. The RBRVS continues to go through refinement. The 5-year review and HCFA's practice expense project are likely to further improve reimbursement for cognitive services. Furthermore, because of the strengths of the scale, the RBRVS is now employed by most payors and is a useful practice management tool. Relative to other specialties, particularly the surgical specialties, neurology has in general benefited from these changes. Yet the RBRVS only addresses the rate of reimbursement; the proliferation of plans and insurance products with different coverage and payment policies and different procedures vastly complicates medical practice management. Understanding the development and evolution of the RBRVS is one necessary element of competent practice management.

Fee Schedules↗