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At least 109 records · Page 6Linked to original sources
PubMed1993

Border crossing for physician services: implications for controlling expenditures.

In this article, the authors explore geographic border crossing for the use of Medicare physician services. Using data from the 1988 Part B Medicare Annual Data (BMAD) file, they find that there is substantial geographic variation across both States and urban and rural areas in border crossing to seek services. As might be expected, there is more border crossing among smaller geographic areas than among States. Predominantly rural areas tend to be major importers of services, but urban areas, on average, export services. Border crossing tends to be greater for high-technology services such as advanced imaging, cardiovascular surgery, and oncology procedures. These results suggest that expenditure-control policies applying to States or metropolitan areas should incorporate adjusters for patients' current geographic patterns of care.

Catchment Area, Health↗
PubMed1996

Privacy Act of 1974; system of records--HCFA.

HCFA is proposing to revise the systems notice for the "Medicare Physician Identification and Eligibility System (MPIES)," System No. 09-70-0525. The following alterations will be made to this system of records: 1. The purpose statement for the system will be revised to better reflect the system's expanded function. The new purpose of this system of records will read as follows: "to maintain unique identification of each physician, practitioner, and medical group practice requesting and/or receiving Medicare reimbursement." 2. The name of the system will be changed from the "Medicare Physician Identification and Eligibility System (MPIES)," to the "Unique Physician/Practitioner Identification Number (UPIN) System." 3. The name of the "Unique Physician Identification Number (UPIN)" will be changed to the "Unique Physician/Practitioner Identification Number." Despite this amendment, the acronym UPIN will not be changed because Federal and state agencies and private and public insurance entities are familiar with the use of this acronym. 4. The structure of the UPIN identifier is being changed from a 6-digit identifier to a 10-digit identifier so as to uniquely identify all physicians, practitioners and medical group practices, and to rectify current problems with existing individualized identification systems. 5. Tax identification numbers will be collected and added to the data fields maintained on all physicians, practitioners, and medical group practices in this system. 6. HCFA is also proposing to add a new routine use (number 10) to this system notice for the release of data to other Federal and state agencies.

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

Payment for non-VA physician services associated with either outpatient or inpatient care provided at non-VA facilities--VA. Proposed rule.

This document proposes to amend Department of Veterans Affairs (VA) medical regulations concerning payment for non-VA physician services that are associated with either outpatient or inpatient care provided to eligible VA beneficiaries at non-VA facilities. We propose that when a service specific reimbursement amount has been calculated under Medicare's Participating Physician Fee Schedule, VA would pay the lesser of the actual billed charge or the calculated amount. We also propose that when an amount has not been calculated, VA would pay the amount calculated under a 75th percentile formula or, in certain limited circumstances, VA would pay the usual and customary rate. In our view, adoption of this proposal would establish reimbursement consistency among federal health benefits programs, would ensure that amounts paid to physicians better represent the relative resource inputs used to furnish a service, and, would, as reflected by a recent VA Office of Inspector General (OIG) audit of the VA fee-basis program, achieve program cost reductions. Further, consistent with statutory requirements, the regulations would continue to specify that VA payment constitutes payment in full.

Fee Schedules↗
PubMed1998

Private contracting.

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Centers for Medicare and Medicaid Services, U.S.↗
PubMedDate not supplied

Medicare private contracting: increasing patient choice and access?

Congress modified the Medicare program through the Balanced Budget Act of 1997 to expand patient choices for payment to physicians and certain other practitioners by allowing private contracting. This represents a shift in policy that has broad consequences for health care financing and program integrity. The effect of private contracting on quality and access to care remains unknown. Quality and access should be the most important measures of its success or failure. Out of pocket costs to seniors and vulnerable patients must also be watched closely.

Aged↗