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Medicare payment policies to physicians / Katherine V. Bergen, editor.
- Format:
- Book
- Series:
- Health care issues, costs and access.
- Health care issues, costs and access
- Language:
- English
- Subjects (All):
- Medicare--Claims administration.
- Medicare.
- Physical Description:
- 1 online resource (166 p.)
- Edition:
- 1st ed.
- Place of Publication:
- New York : Nova Science Publishers, 2009.
- Language Note:
- English
- Summary:
- Explores Medicare spending for physician services that has climbed more than 9 per cent per year, since 2000. This book examines the Medicare law that specifies a formula for calculating the annual update in payments for physicians' services.
- Contents:
- Intro
- MEDICARE PAYMENTPOLICIES TO PHYSICIANS
- CONTENTS
- PREFACE
- OPTIONS TO IMPROVE MEDICARE'SPAYMENTS TO PHYSICIANS, MAY 10, 2007
- ENSURING ACCURATE PRICES
- MEASURING RESOURCE USE AND PROVIDING FEEDBACK
- ENCOURAGING COORDINATION OF CAREAND THE USE OF CARE MANAGEMENT PROCESSES
- PROMOTING THE USE OF PRIMARY CARE
- BUNDLING TO REDUCE OVERUSE
- LINKING PAYMENT TO QUALITY
- RATIVE-EFFECTIVENESS INFORMATION
- USING STANDARDS TO ENSURE QUALITY
- MEDICARE PAYMENT POLICIES*
- ABSTRACT
- INTRODUCTION
- MEDICARE PAYMENT PRINCIPLES
- Medicare Payment Rules
- Beneficiary out-of-Pocket Payments
- RECENT CONGRESSIONAL ACTIONSWITH RESPECT TO PROGRAM PAYMENTS
- MEDICARE PAYMENT POLICIES. PART A
- 1. Inpatient Prospective Payment System (IPPS) for Short-term, General Hospitals
- 2. Hospitals Receiving Special Consideration under Medicare's IPPS
- 3. IPPS-Exempt Hospitals and Distinct Part Units
- 4. Skilled Nursing Facility (SNF) Care
- 5. Hospice Care
- PART B
- 1. Physicians
- 2. Nonphysician Practitioners
- 3. Clinical Diagnostic Laboratory Services
- 4. Preventive Services
- 5. Telehealth
- 6. Durable Medical Equipment (DME)
- 7. Prosthetics and Orthotics
- 8. Surgical Dressings
- 9. Parenteral and Enteral Nutrition (PEN)
- 10. Miscellaneous Items and Services
- 11. Ambulatory Surgical Centers (ASCs)
- 12. Hospital Outpatient Services
- 13. Rural Health Clinics and Federally Qualified Health Center (FQHCs) Services
- 14. Comprehensive Outpatient Rehabilitation Facility (CORF)
- 15. Part B Drugs/Vaccines Covered Incident to a Physician's Visit
- 16. Blood
- 17. Partial Hospitalization Services Connected to Treatment of Mental Illness
- 18. Ambulance Services
- PARTS A AND B
- 1. Home Health
- 2. End-Stage Renal Disease
- PART C
- Managed Care Organizations
- PART D.
- Outpatient Prescription Drug Coverage
- CRS REPORTS FOR ADDITIONAL INFORMATION
- CRS STAFF, BY MEDICARE ISSUE
- REFERENCES
- MEDICARE: PAYMENTS TO PHYSICIANS*
- INTRODUCTION: THE MEDICARE FEE SCHEDULE
- Why the Fee Schedule Was Enacted
- Calculation of the Fee Schedule
- Beneficiary Protections
- Participation Agreements
- Submission of Claims
- Refinements in Relative Value Units
- SUSTAINABLE GROWTH RATE (SGR) SYSTEM
- Conversion Factor Calculation
- Update Adjustment Factor
- Sustainable Growth Rate (SGR)
- Major Changes in Update Calculation
- Criticisms of Current System
- Suggested Modifications
- Recent Actions
- OTHER ISSUES
- 2007 and 2008 Fee Schedules
- Imaging Services
- Impact of Spending Increases on Part B Premiums
- Access to Care
- Geographic Variation in Payments
- Medicare Versus Private Payment Rates
- Payments for Oncology Services
- Concierge Care
- RECENT LEGISLATION
- Changes Made by MMA, DRA, TRHCA
- Legislation in the First Session of the 110th Congress
- Legislation in the Second Session of the 110th Congress: MIPPA
- APPENDIX A. CALCULATION OF THE PHYSICIANFEE SCHEDULE UPDATE
- Calculation of the Physician Fee Schedule
- Calculation of the Update to the Conversion Factor (CF)
- Calculation of the Update Adjustment Factor (UAF)
- APPENDIX B.MMA, DRA, TRCHA, AND MMSEAPROVISIONS RELATING TO PHYSICIANS
- MMA
- DRA
- TRHCA
- MMSEA
- APPENDIX C. GEOGRAPHIC ADJUSTMENTSTO THE PHYSICIAN FEE SCHEDULE
- Legislative Background
- Calculation[37]
- APPENDIX D. DEVELOPMENT OF PRACTICE EXPENSEPAYMENT METHODOLOGY
- Practice Expenses
- APPENDIX E. PRIVATE CONTRACTING RULES
- How Private Contracting Works
- Issues
- INDEX.
- Notes:
- Description based upon print version of record.
- Includes bibliographical references and index.
- Description based on print version record.
- ISBN:
- 1-61470-239-X
- OCLC:
- 776164143
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