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Payment
Payment to Physician from Insurance Company
| Question | Answer |
|---|---|
| Medicare uses a physician fee schedule to determine payments for services. The fee for each service depends on its _________, which rank on a common scale, resources used to provide each service. | Relative Value Units (RVUs) |
| To determine payments for service, each service fee depends on its Relative Value Units (RVUs). Ranking on a common scale, resources used to provide each service. Resources include: | - The physician's work - The expenses of the physician's practice - Professional liability insurance |
| The ______________ has 3 factors included to get the payment amount for each service paid under the physician fee schedule. They are a nationally uniform relative value for service, geographic adjustment factor (GAF), and nationally uniform conversation. | Relative Value Payment Method |
| Physician payment system used by CMS and nearly all HMOs; based on principle that payments for services should vary with resource costs for providing services; intend to improve and stabilize payment system while providing physicians an avenue to improve. | Medicare-Resource-Based Relative Value Scale (RBRVS) |
| Billing a patient for the difference between a higher usual fee and a lower allowed charge, not allowed, and called ______________. | Balance Billing |
| The person receiving a payment or financial reimbursement in written form or electronically through funds transfer is called the ____________. | Payee |
| What is capitation? | A payment structure in which a health maintenance organization (HMO) prepays an annual set fee per patient to a physician. |
Created by:
cattomko
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