Medicare Physician Fee Schedule
Today im going over information about the Medicare Physician Fee
Schedule (PFS) A fee schedule is a complete listing of fees used by Medicare to pay doctors or other providers/suppliers. This comprehensive listing of fee maximums is used to reimburse a physician and/or other providers on a fee-for-service basis.
Medicare Part B
Medicare Part B pays for physician services based
on the Medicare Physician Fee Schedule, which lists the more than 7,400
unique covered services and their payment rates.
Physicians’ services include the following:
™ Office visits;
™ Surgical procedures;
™ Anesthesia services; and
™ A range of other diagnostic and therapeutic
Payment rates for an individual
Payment rates for an individual service are based on
the following components as shown in the Medicare
PFS payment rates formula on page 3:
1) Relative Value Units (RVUs);
• Work RVU;
• Practice Expense (PE) RVU; and
• Malpractice (MP) RVU;
2) Conversion Factor (CF); and
3) Geographic Practice Cost Indices (GPCIs).
The 2016 Physician Fee Schedule final rule
The 2016 Physician Fee Schedule final rule with comment period was placed on display at the Federal Register on October 30, 2015. In addition to policies affecting the calculation of payment rates, this final rule identifies potentially misvalued codes, adds procedures to the telehealth list, and finalizes a number of new policies, including several that are a result of recently enacted legislation. The rule also finalizes changes to several of the quality reporting initiatives that are associated with Physician Fee Schedule payments, including the Physician Quality Reporting System (PQRS), the Physician Value-Based Payment Modifier (Value Modifier), and the Medicare Electronic Health Record (EHR) Incentive Program, as well as changes to the Physician Compare website on Medicare.gov. This is the first Physician Fee Schedule final rule since the repeal of the Sustainable Growth Rate (SGR) formula by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). The calendar year 2016 Physician Fee Schedule final rule is one of the several final rules reflecting a broader Administration-wide strategy to create a health care system that results in better care, smarter spending, and healthier people.
If you would like more Information on Medicare / Medicare PSF or Medigap plans you can contact me at (475) 88CARLY (475)-882-2759