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At least 595 records · Page 33Linked to original sources
PubMed1995

Medicare program; refinements to geographic adjustment factor values, revisions to payment policies, adjustments to the relative value units (RVUs) under the physician fee schedule for calendar year 1995, and the 5-year refinement of RVUs; correction--HCFA. Correction of final rule with comment period.

This document is a second correction to technical errors that appeared in the final rule with comment period entitled "Medicare Program; Refinements to Geographic Adjustment Factor Values, Revisions to Payment Policies, Adjustments to the Relative Value Units (RVUs) Under the Physician Fee Schedule for Calendar Year 1995, and the 5-Year Refinement of RVUs" published in the Federal Register on December 8, 1994. The first correction notice was published in the Federal Register on January 3, 1995 (60 FR 46).

Centers for Medicare and Medicaid Services, U.S.↗
PubMed1997

Medicare program; revisions to payment policies and five-year review of and adjustments to the relative value units under the physician fee schedule for calendar year 1997; correction--HCFA. Correction of final rule with comment period.

This document corrects technical errors that appeared in the final rule with comment period published in the Federal Register on November 22, 1996 entitled "Medicare Program; Revisions to Payment Policies and Five-Year Review of and Adjustments to the Relative Value Units Under the Physician Fee Schedule for Calendar Year 1997."

Centers for Medicare and Medicaid Services, U.S.↗
PubMed1993

Medicare program; revisions to payment policies and adjustments to the relative value units under the physician fee schedule for calendar year 1994--HCFA. Final rule with comment period.

This final rule revises the payment policy for specific physician services and supplies, revises the relative value units (RVUs) assigned to certain existing procedure codes, and establishes interim RVUs for new and revised procedure codes. Section 6102(a) of the Omnibus Budget Reconciliation Act of 1989, as amended by section 4118 of the Omnibus Budget Reconciliation Act of 1990, requires establishment of the physician fee schedule and periodic review and adjustment of the RVUs. Further changes concerning payment for certain physician services are required by sections 13513 through 13517 of the Omnibus Budget Reconciliation Act of 1993.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed1997

Medicare program; delay in implementing the adjustments to the practice expense relative value units under the physician fee schedule for calendar year 1998--HCFA. Notice of intent to regulate.

This notice identifies provisions in the Medicare physician fee schedule regulations that are affected by enactment of the Balanced Budget Act of 1997 (BBA 1997). Section 4505 of the BBA 1997 postpones implementation of a resource-based practice expense relative value unit system until January 1, 1999 and provides for a 4-year transition. In addition, it provides for an adjustment for practice expense relative value units for 1998. It also requires publication of a new proposed rule for practice expense by May 1, 1998, thus requiring significant revision of our proposal contained in the proposed rule published June 18, 1997 (62 FR 33158).

Aged↗
PubMed1998

National Practitioner Data Bank; change in user fee and elimination of diskette queries--HRSA. Withdrawal.

National Practitioner Data Bank; Change in User Fee and Elimination of Diskette Queries notice, document 98-2637, pages 5811-5812, Volume 63, Number 23, in the issue of Wednesday, February 4, 1998, was published in error and is withdrawn from publication. The correct version of the notice was published on Thursday, January 29, 1998, Document No. 98-2116, Volume 63, Number 19, page 4460.

Fees and Charges↗
PubMed1998

Medicare program; revisions to payment policies under the physician fee schedule for calendar year 1999--HCFA. Proposed rule.

This proposed rule would make several policy changes affecting Medicare Part B payment. The changes that relate to physician services include: resource-based practice expense relative value units, medical direction rules for anesthesia services, and payment for abnormal Pap smears. Also, we would rebase the Medicare Economic Index from a 1989 base year to a 1996 base year. Under the law, we are required to develop a resource-based system for determining practice expense relative value units. The Balanced Budget Act of 1997 (BBA 1997) delayed, for 1 year, implementation of the resource-based practice expense relative value units until January 1, 1999. Also, BBA 1997 revised our payment policy for nonphysician practitioners, for outpatient rehabilitation services, and for drugs and biologicals not paid on a cost or prospective payment basis. In addition, BBA 1997 permits certain physicians and practitioners to opt out of Medicare and furnish covered services to Medicare beneficiaries through private contracts. In addition, since we established the physician fee schedule on January 1, 1992, our experience indicates that some of our Part B payment policies need to be reconsidered. This proposed rule is intended to correct inequities in physician payment and solicits public comments on specific proposed policy changes.

Abstracting and Indexing↗
PubMed1981

Medical economics: lab fees and the office visit.

Laboratory fees constitute a significantly greater part of the usual cost for an office visit than they do of the total hospital bill for inpatients. The author of this article shows how much greater, and how the laboratory share of the bill depends on where the testing is performed.

Fees and Charges↗
PubMed1979

Competing on the basis of fees?

The Department of Health, Education, and Welfare recently selected specific laboratory procedures for reimbursement under the lowest charge level criteria, mandated in Section 224 of the 1972 Social Security Amendment. According to the author, such government regulations could force hospital laboratories to compete with independent laboratories on the basis of fees, thereby threatening the former's financial stability. In this article, the author analyzes the problem and proposes a solution.

Fees and Charges↗
PubMed1986

Medicare program; physician fee freeze sanctions--HHS. Final rule.

This final rule sets forth OIG procedures for the imposition of civil money penalties and Medicare program exclusions on physicians who have chosen not to be participating physicians and who have raised charges to Medicare beneficiaries in violation of the freeze on such fees contained in section 2306 of Pub. L. 98-369, the Deficit Reduction Act (DEFRA). This final rule also modifies existing regulations to permit the OIG to impose civil money penalties and assessments on those individuals who have chosen to be participating physicians under the Medicare program and who have violated their participation agreements set forth in section 2306.

Fees, Medical↗
PubMed1988

Working toward a more rational pattern of fees.

Following its congressional mandate to reform physician payment, the Physician Payment Review Commission has been examining the concept of a fee schedule. The commission, which operates almost entirely in public, has extensive contact with physician groups and beneficiary organizations, and provides extensive opportunities for formal testimony at public meetings and for frequent informal interactions at the staff level. By sending various organizations a draft outline of issues it hopes to take up in its next report to Congress, it is soliciting suggestions from them long before any decisions are made. Such issues as geographic variation in payment, the ways in which CPT codes are used, a relative-value scale, and the increasing volume of services are being subjected to intense scrutiny, and the commission is drawing conclusions.

Abstracting and Indexing↗
PubMedDate not supplied

Physician fee-setting requires scrutiny.

To avoid antitrust liability from physician fee-setting in HMOs and PPOs, participating physicians should share the risk of profit and loss. "Health Law" is a regular feature of Physician Executive contributed by the law firm of Epstein Becker and Green, P.C. Douglas A. Hastings, Esq., a partner in the firm's Washington, D.C., offices serves as column editor.

Delivery of Health Care↗
PubMed1999

Prostate cancer treatment and ten-year survival among group/staff HMO and fee-for-service Medicare patients.

OBJECTIVE: To compare treatment patterns and the ten-year survival of prostate cancer patients in two large, nonprofit, group/staff HMOs to those of patients receiving care in the fee-for-service health setting. DATA SOURCES/STUDY DESIGN: A cohort of men age 65 and over diagnosed with prostate cancer between 1985 and the end of 1992 and followed through 1994. Subjects (n = 21,741) were ascertained by two population-based tumor registries covering the greater San Francisco-Oakland and Seattle-Puget Sound areas. Linkage of registry data with Medicare claims data and with HMO inpatient utilization data allowed the determination of health plan enrollment and the measurement of comorbid conditions. Multivariate regression models were used to examine HMO versus FFS treatment and survival differences adjusting for sociodemographic and clinical characteristics. PRINCIPAL FINDINGS: Among cases with non-metastatic prostate cancer, HMO patients were more likely than FFS patients to receive aggressive therapy (either prostatectomy or radiation) in San Francisco-Oakland (odds ratio [OR] = 1.69, 95% CI = 1.46-1.96) but not in Seattle (OR = 1.15, 0.93-1.43). Among men receiving aggressive therapy, HMO cases were three to five times more likely to receive radiation therapy than prostatectomy. Overall mortality was equivalent over ten years (HMO versus FFS mortality risk ratio [RR] = 1.01, 0.94-1.08), but prostate cancer mortality was higher for HMO cases than for FFS cases (RR = 1.25, 1.13-1.39). CONCLUSION: Despite marked treatment differences for clinically localized prostate cancer, overall ten-year survival for patients enrolled in two nonprofit group/staff HMOs was equivalent to survival among patients receiving care in the FFS setting, even after adjustment for sociodemographic and clinical characteristics. Similar overall but better prostate cancer-specific survival among FFS patients is most plausibly explained by differences between the HMO and FFS patients in both tumor characteristics and unmeasured patient selection factors.

Aged↗
PubMed1999

Awareness of and compliance with recommended screening procedures: a comparison of HMO and fee-for-service enrollees.

Managed care organizations, particularly HMOs, have emphasized disease prevention and early detection (screening) programs as a component of high-quality, cost-effective medical care. Studies in the 1980s found higher levels of utilization of screening by HMO enrollees compared with individuals enrolled in fee-for-service (FFS) plans, although this pattern is less clear in more recent reports. This paper reports on an analysis of a survey designed to determine awareness, compliance, and potential barriers to participating in common screening tests by adults living in Hillsborough County (greater Tampa), Florida. A random digit--dialing telephone survey of a stratified random sample of 500 adults over 18 years of age was conducted. Health plan enrollees were found to be younger, more likely to receive health insurance through an employer, and were more likely to have a regular source of health care. Few statistically significant differences, however, were detected in awareness of or compliance with recommended screening procedures between HMO and FFS enrollees in the study. Consistent with other recent research, these findings suggest that the changing nature of managed care, from traditional staff models toward IPA or network-hybrid models, has somewhat reduced HMOs' influence on prevention and screening services.

Adult↗
PubMed1999

Fear and loathing in Florida--PPMC's, fee-splitting, and anti-kickback implications.

Many developments are occurring with respect to practice management agreements in Florida. These include the District Court of Appeal affirmance of the Bakarania decision, a bankruptcy court decision to the effect that the PhyMatrix Agreement evaluated in Bakarania constitutes illegal fee-splitting. There was also a new Board of Medicine decision permitting a percentage arrangement under a "management agreement." This article summarizes the recent developments in Florida, as well as some developments in other states, which are relevant for practice management agreements throughout the country.

Bankruptcy↗
PubMed2000

Fee-for-service joins the Medicare+Choice product line.

Despite hopes that providers would benefit from being able to participate in Medicare + Choice plans such as provider service organizations (PSOs) and coordinated care plans, providers have not realized many of these benefits. Private fee-for-service (FFS) Medicare + Choice plans, the first of which was approved by HCFA in May, allow Medicare beneficiaries to choose their hospitals and physicians and allow providers to be reimbursed on a FFS basis. The FFS option is particularly appealing for providers in rural markets. Financial managers for providers should identify the model that best meets the financial and operational needs of their marketplace.

Aged↗