RESUMEN
Proposed overhaul to Medicare payments for complex patient care visits and same-day office-based procedures could box in Texas physicians.
Asunto(s)
Tabla de Aranceles/normas , Visita a Consultorio Médico/economía , Médicos/economía , Centers for Medicare and Medicaid Services, U.S. , Humanos , Medicare/economía , Texas , Estados UnidosRESUMEN
Objetivo: Investigar se o valor médio geral de remuneração ofertado por três planos odontológicos da cidade de Maceió-AL possuem defasagem, coerência ou ágio em relação ao estabelecido na tabela VRPO-CFO. Materiais e Métodos: foram utilizados três planos odontológicos da cidade de Maceió-AL,acreditando ser esses os de maior procura por parte dos profissionais, para uma comparação entre suas categorias de serviço e as da tabela VRPO, sendo calculado o valor percentual de acréscimo ou defasagem. Resultados: Nota-se que em todas as categorias de serviço, o plano que melhor remunerou foi o plano A, tendo as categorias prevenção, Endodontia, Radiologia e Dentística o menor percentual de defasagem, sendo eles 22%, 26%, 30% e 40%, respectivamente, as demais categorias apresentaram índice acima de 50%. O plano odontológico que pior remunerou, de acordo com a presente pesquisa, foio plano C, com média de defasagem geral de 65%, possuindo a categoria Diagnóstico como o serviço com maior defasagem (83%). Conclusão: Conclui-se que a remuneração dos procedimentos odontológicos,que envolvem todas as especialidades, oferecida por planos odontológicos de Maceió-AL aos Cirurgiões-Dentistas, estão abaixo dos valores determinados na tabela do VRPO-CFO.
Objective: To investigate whe ther the overall average amount of remuneration offered by three dental plans from the city of Maceió-AL have a discrepancy, consistency or goodwill in relation to the established VRPO-CFO table. Materials and Methods: three dental plans from the city of Maceió- ALwere used, believing that these are the most demanded by professionals, for a comparison betweentheir service categories and VRPO table, therefore calculating their increasement percentage valueor lag. Results: We notice that in all service categories, the plan that best remunerated was plan A,having the categories Prevention, Endodontics, Radiology and Dentistry the lowest percentage oflag, namely 22%, 26%, 30% and 40% respectively, the other categories had an index above 50%.The dental plan that pays worse, according to this research, was plan C, with an overall discrepancy average of 65%. Having the Diagnosis service category with the largest lag (83%). Conclusion: We conclude that the remuneration for dental procedures, involving all specialties offered by dental plans in Maceió (AL) to dentists, are lower than the ones determined on the VRPO-CFO table.
Asunto(s)
Humanos , Masculino , Femenino , Valores de Referencia , Remuneración , Tabla de Aranceles/clasificación , Tabla de Aranceles/estadística & datos numéricos , Tabla de Aranceles/ética , Tabla de Aranceles/normas , Tabla de Aranceles/organización & administración , Tabla de ArancelesAsunto(s)
Tabla de Aranceles/economía , Tabla de Aranceles/normas , Reforma de la Atención de Salud/economía , Reforma de la Atención de Salud/normas , Programas Nacionales de Salud/economía , Programas Nacionales de Salud/normas , Mecanismo de Reembolso/economía , Mecanismo de Reembolso/normas , Tabla de Aranceles/legislación & jurisprudencia , Alemania , Reforma de la Atención de Salud/legislación & jurisprudencia , Humanos , Mecanismo de Reembolso/legislación & jurisprudenciaRESUMEN
The Relative Value Scale Update Committee (RUC) plays a critical role in determining physician payment. When the Centers for Medicare and Medicaid Services (CMS) transitioned to paying physicians based on the Resource-Based Relative Value Scale, the American Medical Association developed this unique multispecialty committee. Physicians at the RUC determine the resources required to provide physician services and recommend appropriate payment for those services. The RUC then submits its recommendations to CMS. Physicians have thus been important in determining relative value and hence payment for the services they provide.
Asunto(s)
American Medical Association , Médicos/economía , Escalas de Valor Relativo , Tabla de Aranceles/economía , Tabla de Aranceles/normas , Humanos , Medicare/economía , Medicare/normas , Médicos/normas , Estados UnidosAsunto(s)
Centers for Medicare and Medicaid Services, U.S./economía , Servicios de Diagnóstico/economía , Administración de la Práctica Médica/economía , Contabilidad de Pagos y Cobros , Centers for Medicare and Medicaid Services, U.S./normas , Servicios de Diagnóstico/tendencias , Tabla de Aranceles/normas , Tabla de Aranceles/tendencias , Humanos , Relaciones Interinstitucionales , Administración de la Práctica Médica/tendencias , Escalas de Valor Relativo , Estados UnidosAsunto(s)
Centers for Medicare and Medicaid Services, U.S./economía , Médicos de Atención Primaria/economía , Servicios Preventivos de Salud/economía , Mecanismo de Reembolso/normas , Telemedicina/economía , Centers for Medicare and Medicaid Services, U.S./normas , Centers for Medicare and Medicaid Services, U.S./tendencias , Codificación Clínica/economía , Codificación Clínica/normas , Codificación Clínica/tendencias , Tabla de Aranceles/normas , Tabla de Aranceles/tendencias , Humanos , Área sin Atención Médica , Médicos de Atención Primaria/normas , Médicos de Atención Primaria/tendencias , Servicios Preventivos de Salud/normas , Servicios Preventivos de Salud/tendencias , Mecanismo de Reembolso/tendencias , Servicios de Salud Rural/economía , Servicios de Salud Rural/normas , Servicios de Salud Rural/tendencias , Telemedicina/normas , Telemedicina/tendencias , Estados UnidosAsunto(s)
Medicare/economía , Método de Control de Pagos/normas , Mecanismo de Reembolso/normas , Tabla de Aranceles/normas , Tabla de Aranceles/tendencias , Humanos , Medicare/normas , Medicare/tendencias , Política , Método de Control de Pagos/tendencias , Mecanismo de Reembolso/tendencias , Estados UnidosAsunto(s)
Contabilidad/economía , Contabilidad/normas , Contabilidad de Pagos y Cobros , Auditoría Financiera/normas , Clasificación Internacional de Enfermedades/economía , Clasificación Internacional de Enfermedades/normas , Medicare/economía , Administración de la Práctica Médica/economía , Administración de la Práctica Médica/normas , Tabla de Aranceles/economía , Tabla de Aranceles/normas , Humanos , Reembolso de Seguro de Salud/economía , Reembolso de Seguro de Salud/normas , Estados UnidosRESUMEN
PURPOSE: The aim of this study was to assess potential physician work efficiencies when more than one diagnostic imaging study is interpreted by the same provider during the same session. METHODS: Medicare Physician Fee Schedule data from the American Medical Association Resource-Based Relative Value Scale Data Manager for 2011 were analyzed to quantify relative contributions of preservice, intraservice, and postservice physician work to the total work of rendering diagnostic imaging services. An expert panel review identified potential duplications in preservice and postservice work when multiple examinations are performed on the same patient during the same session. Maximum potential percentage work duplication for various diagnostic imaging modalities was calculated and compared to US Government Accountability Office estimates. RESULTS: The relative contributions of preservice and postservice work to total work varied by modality, ranging from 20% [computed tomography (CT)] to 33% (ultrasound). The maximum percentage of potentially duplicated preservice and postservice activity ranged from 19% (nuclear medicine) to 24% (ultrasound). Maximum mean potentially duplicated work relative value units ranged from 0.0212 for radiography to 0.0953 for magnetic resonance imaging (MRI). Maximum percentage work reduction ranged from 4.32% for CT to 8.15% for ultrasound. This corresponds to maximum professional Physician Fee Schedule reductions of only 2.96% (CT) to 5.45% (ultrasound), approximating an order of magnitude less than the Government Accountability Office's recommendations. CONCLUSION: Although potential efficiencies in physician work occur when multiple services are provided to the same patient during the same session, these are highly variable and considerably less than previously estimated.
Asunto(s)
Diagnóstico por Imagen/economía , Tabla de Aranceles/normas , Medicare/economía , Pautas de la Práctica en Medicina/economía , Current Procedural Terminology , Eficiencia Organizacional , Investigación sobre Servicios de Salud , Humanos , Escalas de Valor Relativo , Estados Unidos , Carga de TrabajoRESUMEN
Medicare Part B pays outpatient physicians according to the billed Current Procedural Terminology (CPT) codes, which differ in procedure and intensity. Since many performed services merely differ by intensity, physicians have an incentive to upcode services to increase profitability of a visit. Using nationally representative data from the 2001 to 2003 Medicare Current Beneficiary Survey, this paper explores the effect of Medicare Part B fee differentials on the upcoding of general office visits (i.e. for established patient visits with CPT codes of 99212-99215). It finds strong evidence that these fee differentials influence physician's coding choice for billing purposes across a variety of specialties. For general office visits, Medicare outlays attributable to upcoding may sum to as much as 15% of total expenditures for such visits. Medicare has much to gain financially by clarifying its classification rules. Until the distinctions between types of Medicare visits are redefined in a way that eliminates ambiguity, upcoding under Medicare Part B is likely to continue.