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
● Consider, in the course of notice and comment rulemaking, impact projections that compare new proposed payment amounts to data on actual physician PEs. Beginning in CY 1999, Medicare began the four year transition to resource-based PE RVUs. In CY 2002, the resource-based PE RVUs were fully transitioned. 1. Current Methodology The following sections discuss the current PE methodology. a. Data Sources There are two primary data sources used to calculate PEs. The American Medical Association’s (AMA) Socioeconomic Monitoring System (SMS) survey data are used to develop the PEs per hour for each specialty. The second source of data used to calculate PEs was originally developed by the Clinical Practice Expert Panels (CPEP). The CPEP data include the supplies, equipment and staff times specific to each procedure. The AMA developed the SMS survey in 1981 and discontinued it in 1999. Beginning in 2002, we incorporated the 1999 SMS survey data into our calculation of the PE RVUs, using a 5-year average of SMS survey data. (See Revisions to Payment Policies and Five-Year Review of and Adjustments to the Relative Value Units Under the Physician Fee Schedule for Calendar Year 2002 final rule, published 28
November 1, 2001 (66 FR 55246).) The SMS PE survey data are adjusted to a common year, 1995. The SMS data provide the following six categories of PE costs: ● Clinical payroll expenses, which are payroll expenses (including fringe benefits) for nonphysician personnel. ● Administrative payroll expenses, which are payroll expenses (including fringe benefits) for nonphysician personnel involved in administrative, secretarial or clerical activities. ● Office expenses, which include expenses for rent, mortgage interest, depreciation on medical buildings, utilities and telephones. ● Medical material and supply expenses, which include expenses for drugs, x-ray films, and disposable medical products. ● Medical equipment expenses, which include expenses depreciation, leases, and rent of medical equipment used in the diagnosis or treatment of patients. ● All other expenses, which include expenses for legal services, accounting, office management, professional association memberships, and any professional expenses not mentioned above. In accordance with section 212 of the BBRA, we established a process to supplement the SMS data for a 29
- 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 and 22: effect in 1997, published on Novemb
- Page 23 and 24: ● Revised requirements for superv
- Page 25 and 26: efinement of work RVUs; and solicit
- Page 27: historical allowed charges. This le
- 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
- Page 73 and 74: the ACR. We have accepted the follo
- Page 75 and 76: ● Clinical Labor for G-codes Rela
- Page 77 and 78: proposed associated prices that we
November 1, 2001 (66 FR 55246).) The SMS PE survey data are<br />
adjusted to a common year, 1995. The SMS data provide the<br />
following six categories <strong>of</strong> PE costs:<br />
● <strong>Clinical</strong> payroll expenses, which are payroll<br />
expenses (including fringe benefits) for nonphysician<br />
personnel.<br />
● Administrative payroll expenses, which are payroll<br />
expenses (including fringe benefits) for nonphysician<br />
personnel involved in administrative, secretarial or<br />
clerical activities.<br />
● Office expenses, which include expenses for rent,<br />
mortgage interest, depreciation on medical buildings,<br />
utilities and telephones.<br />
● Medical material and supply expenses, which include<br />
expenses for drugs, x-ray films, and disposable medical<br />
products.<br />
● Medical equipment expenses, which include expenses<br />
depreciation, leases, and rent <strong>of</strong> medical equipment used in<br />
the diagnosis or treatment <strong>of</strong> patients.<br />
● All other expenses, which include expenses for legal<br />
services, accounting, <strong>of</strong>fice management, pr<strong>of</strong>essional<br />
association memberships, and any pr<strong>of</strong>essional expenses not<br />
mentioned above.<br />
In accordance with section 212 <strong>of</strong> the BBRA, we<br />
established a process to supplement the SMS data for a<br />
29
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