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This concise, authoritative text provides detailed background information, explains all features of the physician payment system and serves as a reference in answering questions about the RBRVS system. This invaluable reference provides the insights and tools needed to understand the RBRVS system and how to calculate payment schedules accurately. * Up-to-date information - covers new payment rules that take effect in 2012 and gives an explanation of how they may affect your practice * How to correct payment schedule calculations - with updated payment policies, payment calculations and information on appropriate use of modifiers * Critical insight into the RBRVS system - provides detailed background information on the RBRVS system, in-depth explanation on the key components and operation of the payment system, geographic adjustments, conversion factors, and limits on physician charges * Easy-to-use tables - includes all the elements necessary to calculate the Medicare payment schedule, including 2012 relative value units (RVUs) and payment policy indicators for each physician's service and geographic practice cost indexes (GPCIs) for each Medicare payment locality
This is the definitive work on Medicare’s prospective payment system (PPS), which had its origins in the 1972 Social Security Amendments, was first applied to hospitals in 1983, and came to fruition with the Balanced Budget Act of 1997. Here, Rick Mayes and Robert A. Berenson, M.D., explain how Medicare’s innovative payment system triggered shifts in power away from the providers (hospitals and doctors) to the payers (government insurers and employers) and how providers have responded to encroachments on their professional and financial autonomy. They conclude with a discussion of the problems with the Medicare Modernization Act of 2003 and offer prescriptions for how policy makers can use Medicare payment policy to drive improvements in the U.S. health care system. Mayes and Berenson draw from interviews with more than sixty-five major policy makers—including former Treasury secretary Robert Rubin, U.S. Representatives Pete Stark and Henry Waxman, former White House chief of staff Leon Panetta, and former administrators of the Health Care Financing Administration Gail Wilensky, Bruce Vladeck, Nancy-Ann DeParle, and Tom Scully—to explore how this payment system worked and its significant effects on the U.S. medical landscape in the past twenty years. They argue that, although managed care was an important agent of change in the 1990s, the private sector has not been the major health care innovator in the United States; rather, Medicare’s transition to PPS both initiated and repeatedly intensified the economic restructuring of the U.S. health care system.
The 31st edition of Medicare RBRVS: The Physicians' Guide provides the much-needed updated information on the new 2022 Medicare Physician Payment Schedule, payment rules, conversion factor, CPT and HCPCS RVUs, and GPCIs that affect the physician practice. This book is a must-have tool for physician practices because it offers invaluable insight and information needed to understand Medicare's resource-based relative value scale (RBRVS) payment system, and to help physician practices establish physician charges and to calculate Medicare payments. FEATURES AND BENEFITS Critical insight into the RBRVS system -- detailed background information on the RBRVS system, an in-depth explanation on the key components and operation of the payment system, use of the RBRVS by Medicare and the private sector, geographic adjustments, conversion factors, limits on physician charges and CMS adoption of the Physician Practice Information Survey Data and other Practice Expense Methodology changes. Updated information on the Medicare Physician Fee Schedule, payment rules and the conversion factor -- covers new payment rules that take effect in 2022. Updated RVUs for CPT(R) 2022 codes including every RVU element -- Physician Work, Practice Expense (Facility and Nonfacility) and Professional Liability Insurance. List of RVUs for CPT and HCPCS-coded procedures and services -- calculate and establish physician charges using RBRVS relative values. List of RVUs for anesthesiology services. List of geographic practice cost indices (GPCIs) for each for each Medicare payment locality -- Physician Work, Practice Expense and Malpractice Insurance.
The 32nd edition of Medicare RBRVS: The Physicians' Guide provides the much-needed updated information on the new 2023 Medicare Physician Payment Schedule, payment rules, background on major coding and legislative changes, CPT, HCPCS, relative value units (RVUs), and GPCIs that affect the physician practice. This book is a must-have tool for physician practices because it offers invaluable insight and information needed to understand Medicare's resource-based relative value scale (RBRVS) payment system, and to understand the calculation of Medicare payments. FEATURES AND BENEFITS Critical insight into the RBRVS system -- detailed background information on the RBRVS system, an in-depth explanation on the key components and policy of the Medicare payment system, use of the RBRVS by the private sector, geographic adjustments, government policy and CMS adoption of the Physician Practice Information Survey Data and other Practice Expense Methodology changes. Updated information on the Medicare Physician Fee Schedule, payment rules and the conversion factor -- covers new payment rules that take effect in 2023. Updated RVUs for CPT® 2023 codes including every RVU component -- Physician Work, Practice Expense (Facility and Non-facility) and Professional Liability Insurance. List of RVUs for CPT and HCPCS - coded procedures and services-- calculate and establish physician payment using RBRVS relative values. List of Base Units for anesthesiology services. List of geographic practice cost indices (GPCIs) for each for each Medicare payment locality -- Physician Work, Practice Expense and Professional Liability Insurance.
Published in time to mark the 30th anniversary of Medicare's first beneficiary payment, Marilyn Moon's up-to-the-minute discussion provides guidance to the general reader and expert alike on reform alternatives, what is likely to happen, and what would and would not greatly damage the program.