2006 proposed fee schedule - American Society of Clinical Oncology
2006 proposed fee schedule - American Society of Clinical Oncology 2006 proposed fee schedule - American Society of Clinical Oncology
C. Components of the Fee Schedule Payment Amounts To calculate the payment for every physician service, the components of the fee schedule (physician work, PE, and malpractice RVUs) are adjusted by a geographic practice cost index (GPCI). The GPCIs reflect the relative costs of physician work, practice expenses, and malpractice insurance in an area compared to the national average costs for each component. Payments are converted to dollar amounts through the application of a CF, which is calculated by the Office of the Actuary and is updated annually for inflation. The general formula for calculating the Medicare fee schedule amount for a given service and fee schedule area can be expressed as: Payment = [(RVU work x GPCI work) + (RVU PE x GPCI PE) + (RVU malpractice x GPCI malpractice)] x CF. D. Most Recent Changes to the Fee Schedule In the November 15, 2004 PFS final rule (69 FR 66236), we refined the resource-based PE RVUs and made other changes to Medicare Part B payment policy. These policy changes included-- ● Supplemental survey data for PE; ● Updated GPCIs for physician work and PE; ● Updated malpractice RVUs; 22
● Revised requirements for supervision of therapy assistants; media; ● Revised payment rules for low osmolar contrast ● Payment policies for physicians and practitioners managing dialysis patients; ● Clarification of care plan oversight CPO) requirements; ● Requirements for supervision of diagnostic psychological testing services; ● Clarifications to the policies affecting therapy services provided incident to a physician's service; ● Requirements for assignment of Medicare claims; ● Additions to the list of telehealth services; ● Changes to payments for drug administration services; and ● Several coding issues. The November 15, 2004, final rule also addressed the following provisions of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) (Pub. L. 108-173): ● Coverage of an initial preventive physical examination. ● Coverage of cardiovascular screening blood tests. ● Coverage of diabetes screening tests. 23
- Page 1 and 2: DEPARTMENT OF HEALTH AND HUMAN SERV
- Page 3 and 4: 2. By mail. You may mail written co
- Page 5 and 6: Rick Ensor (410) 786-5617 (for issu
- Page 7 and 8: service of the U.S. Government Prin
- Page 9 and 10: 4. Proposed Revisions to §413.170
- Page 11 and 12: AGA American Gastroenterological As
- Page 13 and 14: GAO General Accounting Office GPCI
- Page 15 and 16: PLI Professional liability insuranc
- Page 17 and 18: Initially, only the physician work
- Page 19 and 20: This resource-based system was base
- Page 21: effect in 1997, published on Novemb
- Page 25 and 26: efinement of work RVUs; and solicit
- Page 27 and 28: historical allowed charges. This le
- Page 29 and 30: November 1, 2001 (66 FR 55246).) Th
- Page 31 and 32: The CPEPs identified specific input
- Page 33 and 34: codes that the RUC has not yet revi
- Page 35 and 36: procedure: $27,305,408. In this exa
- Page 37 and 38: as a whole. Indirect costs include
- Page 39 and 40: ● The unscaled indirect expense a
- Page 41 and 42: BNF is applied to (multiplied by) t
- Page 43 and 44: NPWP Step 2--Calculation of Charge-
- Page 45 and 46: In Table 11, the scaled total direc
- Page 47 and 48: TABLE 13--Budget Neutrality and Fin
- Page 49 and 50: The following discussion outlines t
- Page 51 and 52: exist, and suggests that the need f
- Page 53 and 54: TABLE 14--Practice Expense Per Hour
- Page 55 and 56: We believe that we have consistentl
- Page 57 and 58: Due to the ongoing refinement by th
- Page 59 and 60: indirect PE methodology is inaccura
- Page 61 and 62: multi-specialty PEAC that were base
- Page 63 and 64: the needed survey or other data or
- Page 65 and 66: PERC/RUC recommendations for these
- Page 67 and 68: eflect the typical number of cast c
- Page 69 and 70: on comments received and additional
- Page 71 and 72: We have reviewed the PE database an
● Revised requirements for supervision <strong>of</strong> therapy<br />
assistants;<br />
media;<br />
● Revised payment rules for low osmolar contrast<br />
● Payment policies for physicians and practitioners<br />
managing dialysis patients;<br />
● Clarification <strong>of</strong> care plan oversight CPO)<br />
requirements;<br />
● Requirements for supervision <strong>of</strong> diagnostic<br />
psychological testing services;<br />
● Clarifications to the policies affecting therapy<br />
services provided incident to a physician's service;<br />
● Requirements for assignment <strong>of</strong> Medicare claims;<br />
● Additions to the list <strong>of</strong> telehealth services;<br />
● Changes to payments for drug administration<br />
services; and<br />
● Several coding issues.<br />
The November 15, 2004, final rule also addressed the<br />
following provisions <strong>of</strong> the Medicare Prescription Drug,<br />
Improvement, and Modernization Act <strong>of</strong> 2003 (MMA)<br />
(Pub. L. 108-173):<br />
● Coverage <strong>of</strong> an initial preventive physical<br />
examination.<br />
● Coverage <strong>of</strong> cardiovascular screening blood tests.<br />
● Coverage <strong>of</strong> diabetes screening tests.<br />
23
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