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Medicare fees for physician services are resource-based.

Paul L Grimaldi1

  • 1State Healthcare Division of Affiliated Computer Services, Inc., Rockville, MD, USA.

Journal of Health Care Finance
|June 25, 2002
PubMed
Summary

Medicare uses a resource-based relative value scale (RBRVS) for physician fees since 1992. This system determines payments, impacting patient responsibility and physician billing practices.

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Area of Science:

  • Health Economics
  • Medical Billing and Coding

Background:

  • Medicare adopted the Resource-Based Relative Value Scale (RBRVS) in 1992 to set physician payment rates.
  • The RBRVS system changed how Medicare reimburses healthcare providers for services rendered.

Purpose of the Study:

  • To explain the structure of Medicare's physician fee system under RBRVS.
  • To outline patient financial responsibilities within the RBRVS framework.
  • To highlight the impact of RBRVS on the physician billing and coding process.

Main Methods:

  • Analysis of Medicare's payment methodology.
  • Description of the RBRVS fee schedule implementation.
  • Examination of patient cost-sharing mechanisms.

Main Results:

  • Medicare reimburses 80% of the lower of billed or fee schedule amounts.
  • Patients are liable for the remaining 20%, a $100 Part B deductible, and potential excess charges.
  • The RBRVS system decoupled physician charges from Medicare's payment amounts.

Conclusions:

  • The RBRVS system fundamentally altered the physician payment landscape.
  • Significant adjustments to medical coding and billing were necessitated by RBRVS implementation.
  • Understanding RBRVS is crucial for both providers and patients navigating Medicare services.

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