2006 proposed fee schedule - American Society of Clinical Oncology

the MA organization’s payment for services provided under
its direct or indirect contract with the FQHC and are
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prohibited by statute from being included in our calculation
of supplemental payments due to the Medicare FQHC. In other
words, in determining the difference between payments from
the MA organization to the FQHC and what the FQHC will
receive on a cost basis, we are precluded from using the
incentive payments in the calculation of the FQHC
supplemental payment. Only capitated per month per
beneficiary or fee-for-service payments from the MA plan for
services furnished to MA enrollees are included in the
calculations of the rate differential.
Under original Medicare, each center is paid an all-
inclusive per visit rate based on its reasonable costs as
reported in the FQHC cost report. The payment is
calculated, in general, by dividing the center’s total
allowable cost by the total number of visits for FQHC
services. At the beginning of the rate year, the Medicare
Fiscal Intermediary (FI) calculates an interim rate based on
estimated allowable costs and visits from the center if it
is new to the FQHC program or actual costs and visits from
the previous cost reporting period for existing FQHCs. The
center’s interim rate is reconciled to actual reasonable
costs at the end of the cost reporting period.
Proposed Payment Methodology