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The RBRVS for each CPT code is determined using three separate factors: physician work, practice expense, and malpractice expense. The average relative weights of these are: physician work (52%), practice expense (44%), malpractice expense (4%). [2] A method to determine the physician work value was the primary contribution made by the Hsiao study.
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]
Usual, customary, and reasonable (UCR) is an American method of generating health care prices, [1] described as "more or less whatever doctors decided to charge". [2] According to Steven Schroeder , Wilbur Cohen inserted UCR into the Social Security Act of 1965 "in an unsuccessful attempt to placate the American Medical Association ". [ 3 ]
Bundled payment is the reimbursement of health care providers (such as hospitals and physicians) "on the basis of expected costs for clinically-defined episodes of care."
Medical billing, a payment process in the United States healthcare system, is the process of reviewing a patient's medical records and using information about their diagnoses and procedures to determine which services are billable and to whom they are billed. [1] This bill is called a claim. [2]
Blue Cross Blue Shield is an association of 35 independent U.S. health insurance companies. The association does not provide bonuses for vaccinating a set number of child patients.
Fee-for-service (FFS) is a payment model where services are unbundled and paid for separately. [1]In health care, it gives an incentive for physicians to provide more treatments because payment is dependent on the quantity of care, rather than quality of care.
Pay for performance systems link compensation to measures of work quality or goals. Current methods of healthcare payment may actually reward less-safe care, since some insurance companies will not pay for new practices to reduce errors, while physicians and hospitals can bill for additional services that are needed when patients are injured by mistakes. [1]