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Resource-based relative value scale. Resource-based relative value scale ( RBRVS) is a schema used to determine how much money medical providers should be paid. It is partially used by Medicare in the United States and by nearly all health maintenance organizations (HMOs). RBRVS assigns procedures performed by a physician or other medical ...
The Omnibus Budget Reconciliation Act of 1989 enacted a Medicare fee schedule, and as of 2010 about 7,000 distinct physician services were listed. The services are classified under a nomenclature based on the Current Procedural Terminology (CPT) to which the American Medical Association holds intellectual property rights. [2]
Before the 1992 implementation of the Medicare fee schedule, physician payments were made under the "usual, customary and reasonable" payment model (a "charge-based" payment system). Physician services were largely considered to be misvalued under this system, with evaluation and management services being undervalued and procedures overvalued. [3]
Medicare is a federal health insurance program in the United States for people age 65 or older and younger people with disabilities, including those with end stage renal disease and amyotrophic lateral sclerosis (ALS or Lou Gehrig's disease). It was begun in 1965 under the Social Security Administration and is now administered by the Centers ...
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Geographic pricing cost index. Geographic Practice Cost Index is used along with Relative Value Units by Medicare to determine allowable payment amounts for medical procedures. There are multiple GPCIs: Cost of Living, Malpractice, and Practice Cost/Expense. These categories allow Medicare to adjust reimbursement rates to take into account ...
APCs or Ambulatory Payment Classifications are the United States government's method of paying for facility outpatient services for the Medicare (United States) program. A part of the Federal Balanced Budget Act of 1997 made the Centers for Medicare and Medicaid Services create a new Medicare "Outpatient Prospective Payment System " (OPPS) for ...
The estimated SGR to go into effect on March 1, 2010, was -8.8%, and the conversion factor for the physician fee schedule was -21.3%. [4] On March 3, 2010, Congress delayed the enforcement of the conversion factor until April 1, 2010, with the passage of the Temporary Extension Act of 2010. [7] [8] On April 15, 2010, Congress enacted the ...