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PubMed1990

The Physician Payment Review Commission: a 1990 update.

Major changes have been effected in Medicare Part B payment policy during the past year. Many of the objectives of both the PPRC and the ACS have been attained, and implementation of the reform measures will take place over the next five years. Much work remains to be done to polish the technical factors that are necessary for implementation, but current progress is on schedule. The single major difference of opinion between the PPRC and the ACS is related to the provision for a separate MVPS for surgical procedures. Clearly, better data are required before this issue can be resolved, and continued cooperation will be necessary to satisfy the congressional mandate for separate surgical and nonsurgical MVPSs. Payment for Medicaid services frequently is woefully inadequate, and the PPRC feels a strong obligation to make appropriate recommendations to Congress in order to correct these inequities. Finally, the PPRC and the ACS are on record as strongly opposing the administration's budget proposals for 1991 and instead as having supported congressional counterproposals that would result in much less severe reductions in Part B outlays.

Health Expenditures↗
PubMedDate not supplied

But 'twas a famous victory.

The Omnibus Budget Reconciliation Act of 1989 sets forth the basic parameters for physician payment reform. The program requires the Health Care Financing Administration to (1) set (regulate) all physicians' fees for services delivered under Part B of Medicare commencing January 1, 1992, with a four-year phase-in period, (2) limit the dollar amounts of balance billing by tying those amounts to the regulated rates, and (3) establish "Volume Performance Standard Rates of Increase" (previously known as "Expenditure Targets") as a mechanism for attempting to regulate the quantities of services delivered.

Fee Schedules↗
PubMedDate not supplied

'90s may be decade for physician payment reform.

The '80s in health care were characterized by reform of Medicare payment for hospital services. The '90s are likely to be characterized by reforms in the manner in which physicians are paid for services to Medicare beneficiaries. In this article, the authors examine the steps that are already under way or proposed for reforms in the payment for physician services under Medicare.

Fee Schedules↗
PubMedDate not supplied

Do these guys know why they're applauding?

Contained in Title IV, Section 6102, of the Omnibus Budget Reconciliation Act of 1989 are more than 21 pages of legislative language designed to require the Health Care Financing Administration (HCFA) to set all physicians' fees for services delivered under Part B of Medicare commencing January 1, 1992, and phased in over the following four years. In addition, balance billing dollar limits keyed to the regulated rates are set forth, as are "Volume Performance Rates of Increase," a reincarnation of a vehicle previously known as "Expenditure Targets."

Economics, Medical↗
PubMed1990

Reports to Congress: Medicare physician payment.

This single volume presents three congressionally mandated reports that provide detailed evaluations of technical and administrative issues associated with implementing proposed physician payment systems under Medicare. The reports were released to Congress on October 18, 1989. It is expected that Congress will use these reports to address the issues identified herein.

Capitation Fee↗
PubMed1990

Understanding volume: a Medicare primer.

Volume, rather than real fee increases, has been the driving force behind increasing physicians' costs throughout the 1970s and the 1980s, these researchers from the Health Care Financing Administration say. But where has it been growing?

Economics, Medical↗
PubMed1992

Contract health care services; reimbursement and Medicare allowable rates--Bureau of Prisons, Dept. of Justice. Notice.

The Bureau of Prisons is issuing this Statement of Policy to inform the public that when it becomes necessary to supplement the direct delivery system of health care the Bureau provides to persons committed to its custody, the Bureau ordinarily will contract to purchase health services only with those hospitals, physicians and other health care providers which agree to accept, as payment in full, reimbursement at rates no higher than the prevailing Medicare allowable rates (including deductibles and co-payments). This encompasses those rates established by the Health Care Financing Administration as "sole community providers" or "regional referral centers". The Bureau will phase this policy into the administration of its contract health services program.

Contract Services↗
PubMedDate not supplied

The philosophy behind setting your group's fees.

According to author Gregory Burgess, fee adjustments are an invitable part of practice management; therefore, increasing the odds that a payment will be allowed when increased is a necessity. His article explains how to use insurance reimbursement data to do just that.

Actuarial Analysis↗
PubMed1992

Policy issues for physicians involved in home care.

The demand for home care services of all varieties will continue to grow in the next two decades, as will the need for well-informed physicians as members of the home health care team. It is hoped that an enlightened society will continue to develop reimbursement and regulatory structures that will foster a larger role for physicians in home care.

Aged↗