decisionhealth Newsletters, Answer Books - 2008 Issue 5 (May)
Medicare_Carriers_Manual / 8042 / 8042
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Article Overview
This article explains Medicare reimbursement policy for provider-based physicians whose employment and compensation relationships with a provider have changed. It focuses on how program payment, reasonable costs, and reasonable charges are evaluated for administrative, teaching, and direct medical care services, along with the circumstances under which the provider’s arrangement may be accepted as reasonable. The material is relevant to hospital billing staff, physician practice administrators, reimbursement analysts, and others working with Medicare cost reporting and charge-setting.
Why This Topic Matters
It helps readers understand how a change in physician compensation arrangements can affect Medicare reimbursement and charge development for provider-based services.
Article Sections
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8042. Reimbursement for provider-based physicians' administrative, teaching, and direct medical care services where the physicians have changed their compensation arrangements with the provider
Describes the reimbursement context for provider-based physicians after changes in employment and compensation relationships. Discusses the broad categories of services involved and how provider arrangements are evaluated for Medicare payment purposes.
What You Will Learn
- How Medicare frames reimbursement when provider-based physician compensation arrangements change
- The general distinction between administrative, teaching, and direct patient care services in this context
- The types of provider and carrier considerations involved in reasonable cost and reasonable charge review
- The broad circumstances that affect whether a new arrangement may be accepted for payment purposes
Who Should Read This
- Hospital reimbursement staff
- Physician practice administrators
- Medical coders and billing staff
- Healthcare finance professionals
- Medicare cost report preparers
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