Medicare aids individuals who have reached retirement age or are otherwise partially or totally disabled to meet medical needs without having to pay huge sums of money. This is because Medicare is a government organized medical and health benefit plan. One very important thing to remember with Medicare is that it may not cover the entire amount expended. For this purpose a Medicare fee schedule can be used. With this an individual need not wait for the hospital and/or doctor\’s quote. More importantly the fee schedule requires a price ceiling on hospital fees, procedures, prescriptions as well as professional fees. This article

For example Mr. A is hospitalized because of a car accident. As it so happens his Medicare plan does not cover the entire inpatient and outpatient procedures as well as the medical procedures and prescription medication. Without a fee schedule Mr. A is left in the dark as to the amount he has to pay for professional fees. This will definitely cause a great deal of anxiety. Because of the fee schedule Mr. A can determine or at least estimate the ceiling amount he has to pay. Therefore a fee schedule not only helps ease tension and anxiety but allows Mr. A more time to prepare to meet the expenses.

Fee Adjustments

It is very important to take note of the fact that fee schedule may adjust depending on several factors like:

1. Cost of hospital accommodation (usually teaching hospitals charge less)

2. Cost of Living in a particular locality

3. Residency or citizenship in the locality where the procedure is to occur

Public Hospital

Most public hospitals do not charge steep fees therefore Medicare may cover the entire procedure. However just to be sure, Medicare fee schedule also applies to public hospitals. However, take note that public hospitals rarely accommodate requests or specifications as to the attending physicians

Rules

1. As of January 1, 2010 the consultation codes for the following is no longer reimbursable under Medicare Part B

– Office/ Outpatient: 99241-99245

– Office/Inpatient99251-99255 for inpatient

2. 6% increase in the RVU value for outpatient E/M services for

– 99201-99205 for new patients,

– 99211-99215 for established patients

In this particular case a physician may choose an E/M code based on 3 years data on a patient.

3. All Physicians (before this only applies to the admitting physician). First encounter with a patient will be governed by CPT codes 99221-99223.

4. Advanced Imaging Services: The current rules require the technical components to meet certain guidelines and to pass accreditation as a pre requisite for reimbursement.

5. Pay Cut: The most welcome adjustment is the fact that professional fees of physicians are projected to be at least 20%.

These are only the more important points on professional Medicare fee schedules. For a more complete explanation or a more specialized discussion based on your particular situation you can visit the hotline, website or walk in on your local Medicare provider. Either that or read thru the entire 2010 Part B Physician Fee Schedule which is more than 1,500 pages.

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Category: Finances
Keywords: fee schedule,medicare fee schedule,professional fees