Medical Fee Schedule

Listing of medical procedure codes and descriptions with fees and relative value units.

Miriam Laugesen goes to the heart of U.S. medical pricing: to a largely unknown committee of organizations affiliated with the American Medical Association. Medicare’s ready acceptance of this committee’s advisory recommendations sets off a chain reaction across the American health care system, leading to high—and disproportionate—rate setting.

Clinical laboratory tests play an integral role in helping physicians diagnose and treat patients. New developments in laboratory technology offer the prospect of improvements in diagnosis and care, but will place an increased burden on the payment system. Medicare, the federal program providing coverage of health-care services for the elderly and disabled, is the largest payer of clinical laboratory services. Originally designed in the early 1980s, Medicare's payment policy methodology for outpatient laboratory services has not evolved to take into account technology, market, and regulatory changes, and is now outdated. This report examines the current Medicare payment methodology for outpatient clinical laboratory services in the context of environmental and technological trends, evaluates payment policy alternatives, and makes recommendations to improve the system.

Miriam Laugesen goes to the heart of U.S. medical pricing: to a largely unknown committee of organizations affiliated with the American Medical Association. Medicare’s ready acceptance of this committee’s advisory recommendations sets off a chain reaction across the American health care system, leading to high—and disproportionate—rate setting.

For healthcare providers and patients alike, the ways of private third-party payer payment systems can be mysterious and oftentimes quite frustrating. Payment for hospital, nursing, or homecare services can be subject to a variety of payment systems including cost-based and charge-based or those with payments that are determined in advance. Knowing the specific rules needed to navigate each type of payment system is essential for all healthcare administrators and accountants. Healthcare Payment Systems: Fee Schedule Payment System, the second volume in a series by expert consultant and workshop facilitator Duane Abbey, is dedicated to fee schedule payment systems. Always accessible and entertaining in his approach, Dr. Abbey illustrates the diverse challenges involved with these systems through the discussion of reimbursement claims for several individuals in a fictitious community served by a hospital, a nursing facility, and a hospice among other healthcare providers, Including more than 60 very real scenarios that illustrate best practices for various fee payment challenges, this comprehensive volume — Explores the general concept of usual, customary, and reasonable (UCR) that is often applied by private third-party payers Provides web links to a number of essential resources including various government acts and manuals Discusses in-depth what is arguably the most complex fee schedule system: the Medicare Physician Fee Schedule Defines a comprehensive list of acronyms used in the medical payment industry Conceptually, fee schedule payment systems are one of the simpler approaches; however, even straightforward healthcare payment systems can, and indeed do, become quite complex. No payment system exists in a vacuum. In fact, when services are provided, the reimbursement from multiple payment systems may be required. This guide shows you how all these systems work, as well as how they interface with one another in everyday practical use. Understanding the differences among systems and learning how to navigate them can make a huge difference in whether a claim is accepted or not and how much payment is allowed.