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  2. Relative value unit - Wikipedia

    en.wikipedia.org/wiki/Relative_value_unit

    Before RVUs were used, Medicare paid for physician services using "usual, customary and reasonable" rate-setting which led to payment variability. [2] The Omnibus Budget Reconciliation Act of 1989 enacted a Medicare fee schedule, and as of 2010 about 7,000 distinct physician services were listed. [ 2 ]

  3. Prospective payment system - Wikipedia

    en.wikipedia.org/wiki/Prospective_payment_system

    In 2000, CMS changed the reimbursement system for outpatient care at Federally Qualified Health Centers (FQHCs) to include a prospective payment system for Medicaid and Medicare. [2] Under this system, health centers receive a fixed, per-visit payment for any visit by a patient with Medicaid, regardless of the length or intensity of the visit.

  4. Current Procedural Terminology - Wikipedia

    en.wikipedia.org/wiki/Current_Procedural_Terminology

    New editions are released each October, [2] with CPT 2021 being in use since October 2021. It is available in both a standard edition and a professional edition. [3] [4] CPT coding is similar to ICD-10-CM coding, except that it identifies the services rendered, rather than the diagnosis on the claim.

  5. Resource-based relative value scale - Wikipedia

    en.wikipedia.org/wiki/Resource-based_relative...

    Using the 2005 Conversion Factor of $37.90, Medicare paid 1.57 * $37.90 for each 99213 performed, or $59.50. Most specialties charge 200–400% of Medicare rates for their procedures and collect between 50 and 80% of those charges, after contractual adjustments and write-offs. [citation needed]

  6. Mastering Medicare, part 3: An expert shares the key dates to ...

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  7. Independent Payment Advisory Board - Wikipedia

    en.wikipedia.org/wiki/Independent_Payment...

    The Independent Payment Advisory Board (IPAB) was to be a fifteen-member United States government agency created in 2010 by sections 3403 and 10320 of the Patient Protection and Affordable Care Act which was to have the explicit task of achieving specified savings in Medicare without affecting coverage or quality.

  8. Medicare can pay for obesity drugs like Wegovy for certain ...

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    The Centers for Medicare & Medicaid Services issued new guidance that says Medicare Part D drug benefit plans — which are offered through private insurers — could cover anti-obesity drugs that ...

  9. 'It doesn't make sense': Why millions of children have lost ...

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    Isabella appears to have been caught up in the rocky aftermath of one of the biggest shake-ups in Medicaid’s 60-year history. When the Covid public health emergency was ending, the federal ...