LEADER 05471nam 2200565 a 450 001 9910964769503321 005 20251117080307.0 010 $a1-61470-239-X 035 $a(CKB)2670000000149076 035 $a(EBL)3019489 035 $a(SSID)ssj0000691359 035 $a(PQKBManifestationID)12266524 035 $a(PQKBTitleCode)TC0000691359 035 $a(PQKBWorkID)10633269 035 $a(PQKB)11586211 035 $a(MiAaPQ)EBC3019489 035 $a(Au-PeEL)EBL3019489 035 $a(CaPaEBR)ebr10671054 035 $a(OCoLC)776164143 035 $a(BIP)26948038 035 $a(EXLCZ)992670000000149076 100 $a20090801d2009 uy 0 101 0 $aeng 135 $aur|n|---||||| 181 $ctxt 182 $cc 183 $acr 200 00$aMedicare payment policies to physicians /$fKatherine V. Bergen, editor 205 $a1st ed. 210 $aNew York $cNova Science Publishers$d2009 215 $a1 online resource (166 p.) 225 1 $aHealth care issues, costs and access 300 $aDescription based upon print version of record. 311 08$a1-60741-131-8 320 $aIncludes bibliographical references and index. 327 $aIntro -- 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. 327 $aOutpatient Prescription Drug Coverage -- CRS REPORTS FOR ADDITIONAL INFORMATION -- CRS STAFF, BY MEDICARE ISSUE -- REFERENCES -- MEDICARE: PAYMENTS TO PHYSICIANS* -- ABSTRACT -- 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 -- REFERENCES -- INDEX. 330 $aExplores Medicare spending for physician services that has climbed more than 9 per cent per year, since 2000. This book examines the Medicare law that specifies a formula for calculating the annual update in payments for physicians' services. 410 0$aHealth care issues, costs and access. 606 $aMedicare$xClaims administration 615 0$aMedicare$xClaims administration. 676 $a368.4/2600973 701 $aBergen$b Katherine V$01869897 801 0$bMiAaPQ 801 1$bMiAaPQ 801 2$bMiAaPQ 906 $aBOOK 912 $a9910964769503321 996 $aMedicare payment policies to physicians$94478176 997 $aUNINA