2006 proposed fee schedule - American Society of Clinical Oncology

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We are proposing a supplemental payment method based on
a per visit calculation subject to an annual reconciliation.
The supplemental payment for FQHC covered services rendered
to MA enrollees is equal to the difference between 100
percent of the FQHC’s all-inclusive cost-based per visit
rate and the average per visit rate received by the center
from the MA plan in which the enrollee is enrolled, less any
amount the FQHC may charge as described in section
1857(e)(3)(B) of the Act. Each center will be required to
submit (for the first rate year) to the intermediary an
estimate of the average MA payment per visit for covered
FQHC services. Every eligible center will be required to
submit a detailed estimate of its average per visit payment
for enrollees in each MA plan offered by the MA organization
and any other information as may be required to enable the
intermediary to accurately establish an interim supplemental
payment, which will be the difference between the estimated
MA per visit payment rate and the center’s interim all-
inclusive cost-based per visit rate. Expected payments from
the MA plan will only be used until actual MA revenue and
visits can be collected on the center’s FQHC cost report.
The interim and final supplemental payment amount will vary
by center depending on its current Medicare reimbursement
rates and its contractual arrangements with MA plans.