The new "Indigenous health" incentive payment: issues and challenges.

PubMed

Couzos, Sophie; Delaney Thiele, Dea

2010-02-01

Paying incentives above the baseline Medicare Benefits Schedule to health services for the additional work required to meet the health needs of Aboriginal people or Torres Strait Islanders might mitigate inequalities of care, but evidence supporting this is lacking. The proposed "Indigenous health" incentive payment to reduce Aboriginal health disadvantage, which is largely aimed at increasing the responsiveness of mainstream general practices, provides an opportunity to examine the assumptions behind this and other recent health reform bids. Contentious implementation issues include: the ineligibility of several Aboriginal community controlled health services (ACCHSs) to receive this payment; determining Aboriginality and the potential for misappropriation of payments; the difficulty accounting for practice population diversity and patient mobility; and concerns about the benefits or otherwise to the Aboriginal community. Evaluation of the measure will present problems: to attribute outcomes, an evaluation must disaggregate outcomes by type of service provider (general practice or ACCHS). If these challenges are not addressed, this initiative may end up merely funding coordination of care for those Aboriginal people and Torres Strait Islanders who are already regular users of the health system.

Advancing the application of systems thinking in health: provider payment and service supply behaviour and incentives in the Ghana National Health Insurance Scheme--a systems approach.

PubMed

Agyepong, Irene A; Aryeetey, Geneieve C; Nonvignon, Justice; Asenso-Boadi, Francis; Dzikunu, Helen; Antwi, Edward; Ankrah, Daniel; Adjei-Acquah, Charles; Esena, Reuben; Aikins, Moses; Arhinful, Daniel K

2014-08-05

Assuring equitable universal access to essential health services without exposure to undue financial hardship requires adequate resource mobilization, efficient use of resources, and attention to quality and responsiveness of services. The way providers are paid is a critical part of this process because it can create incentives and patterns of behaviour related to supply. The objective of this work was to describe provider behaviour related to supply of health services to insured clients in Ghana and the influence of provider payment methods on incentives and behaviour. A mixed methods study involving grey and published literature reviews, as well as health management information system and primary data collection and analysis was used. Primary data collection involved in-depth interviews, observations of time spent obtaining service, prescription analysis, and exit interviews with clients. Qualitative data was analysed manually to draw out themes, commonalities, and contrasts. Quantitative data was analysed in Excel and Stata. Causal loop and cause tree diagrams were used to develop a qualitative explanatory model of provider supply incentives and behaviour related to payment method in context. There are multiple provider payment methods in the Ghanaian health system. National Health Insurance provider payment methods are the most recent additions. At the time of the study, the methods used nationwide were the Ghana Diagnostic Related Groupings payment for services and an itemized and standardized fee schedule for medicines. The influence of provider payment method on supply behaviour was sometimes intuitive and sometimes counter intuitive. It appeared to be related to context and the interaction of the methods with context and each other rather than linearly to any given method. As countries work towards Universal Health Coverage, there is a need to holistically design, implement, and manage provider payment methods reforms from systems rather than linear perspectives, since the latter fail to recognize the effects of context and the between-methods and context interactions in producing net effects.

Transforming Mobile Platform with KI-SIM Card into an Open Mobile Identity Tool

NASA Astrophysics Data System (ADS)

Hyppönen, Konstantin; Hassinen, Marko; Trichina, Elena

Recent introduction of Near Field Communication (NFC) in mobile phones has stimulated the development of new proximity payment and identification services. We present an architecture that facilitates the use of the mobile phone as a personalised electronic identity tool. The tool can work as a replacement for numerous ID cards and licenses. Design for privacy principles have been applied, such as minimisation of data collection and informed consent of the user. We describe an implementation of a lightweight version of the of the mobile identity tool using currently available handset technology and off-the-shelf development tools.

49 CFR 24.503 - Replacement housing payment for 90-day mobile home occupants.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 49 Transportation 1 2010-10-01 2010-10-01 false Replacement housing payment for 90-day mobile home... ASSISTANCE AND REAL PROPERTY ACQUISITION FOR FEDERAL AND FEDERALLY-ASSISTED PROGRAMS Mobile Homes § 24.503 Replacement housing payment for 90-day mobile home occupants. A displaced tenant or owner-occupant of a mobile...

Payments discourage coordination in ecosystem services provision: evidence from behavioral experiments in Southeast Asia

NASA Astrophysics Data System (ADS)

Bell, Andrew; Zhang, Wei

2016-11-01

The contribution of synthetic pesticides to closing yield gaps around the world is undeniable; however, their use is also a classic double-edged sword. Beyond the well-recognized social costs (e.g., pollution to soil and water, and health effects both on consumers and other species) there are also private costs on farmers beyond the direct costs of inputs, associated with elevated risks of both acute and chronic damage to farmers’ health, and with the destruction of populations of beneficial organisms. Managing agricultural land use to enhance natural pest control services (also called mobile agent-based ecosystem services or MABES) holds promise to reduce this growing reliance on pesticides, though it too carries costs. In particular, uncertainty in crop yield due to pest damages, as well as the need to coordinate pesticide use with neighboring farms, can be important obstacles to establishing the longer-term public good of natural pest regulation. Current thinking on promoting ecosystem services suggests that payments or other economic incentives are a good fit for the promotion of public good ecosystem services such as MABES. We undertook a framed field experiment to examine the role of subsidies for non-crop habitat in improving insect-based ecosystem services in two separate samples in Southeast Asia—Cambodia and Vietnam. Our central finding is that these two contexts are not poised equally to benefit from incentives promoting MABES, and in fact may be left worse off by payments schemes. As the study and practice of payments for ecosystem services programs grows, this finding provides an important qualifier on recent theory supporting the use of payments to promote public good ecosystem services—where the nature of the coordination problem is complex and nonlinear, farm systems can be made worse off by being encouraged to attempt it.

Advancing the application of systems thinking in health: provider payment and service supply behaviour and incentives in the Ghana National Health Insurance Scheme – a systems approach

PubMed Central

2014-01-01

Background Assuring equitable universal access to essential health services without exposure to undue financial hardship requires adequate resource mobilization, efficient use of resources, and attention to quality and responsiveness of services. The way providers are paid is a critical part of this process because it can create incentives and patterns of behaviour related to supply. The objective of this work was to describe provider behaviour related to supply of health services to insured clients in Ghana and the influence of provider payment methods on incentives and behaviour. Methods A mixed methods study involving grey and published literature reviews, as well as health management information system and primary data collection and analysis was used. Primary data collection involved in-depth interviews, observations of time spent obtaining service, prescription analysis, and exit interviews with clients. Qualitative data was analysed manually to draw out themes, commonalities, and contrasts. Quantitative data was analysed in Excel and Stata. Causal loop and cause tree diagrams were used to develop a qualitative explanatory model of provider supply incentives and behaviour related to payment method in context. Results There are multiple provider payment methods in the Ghanaian health system. National Health Insurance provider payment methods are the most recent additions. At the time of the study, the methods used nationwide were the Ghana Diagnostic Related Groupings payment for services and an itemized and standardized fee schedule for medicines. The influence of provider payment method on supply behaviour was sometimes intuitive and sometimes counter intuitive. It appeared to be related to context and the interaction of the methods with context and each other rather than linearly to any given method. Conclusions As countries work towards Universal Health Coverage, there is a need to holistically design, implement, and manage provider payment methods reforms from systems rather than linear perspectives, since the latter fail to recognize the effects of context and the between-methods and context interactions in producing net effects. PMID:25096303

47 CFR 3.76 - Licensee's liability for payment.

Code of Federal Regulations, 2010 CFR

2010-10-01

... ACCOUNTING AUTHORITIES IN MARITIME AND MARITIME MOBILE-SATELLITE RADIO SERVICES Enforcement § 3.76 Licensee's... licensee and the accounting authority. In the event that an accounting authority does not remit proper and... arrangements for another accounting authority to perform future settlements, and (b) The ship station licensee...

Research on Credit Evaluation of Mobile Medical APP Interactive Online Consultation Service-Take Haodaifu APP Online Payment Service as an Example

NASA Astrophysics Data System (ADS)

Xiong, Dandan; Zhao, Lei

2017-10-01

Mobile medical industry is developing rapidly, but the relevant credit evaluation system is still in the exploratory stage. Haodaifu in the interactive online consulting services more representatives and has a credit evaluation system, but the system is not perfect. There are many problems in the system, such as credits indicators cannot better reflect the results of user’s evaluation, the lack of user qualification supervision, evaluation index system and assessment channels are not perfect. On the basis of drawing on the advantages of E-commerce evaluation system and combining with the characteristics of mobile medical itself, two suggestions are put forward: Improve the credit evaluation model (Generate physician static credit index, Change the doctor 's dynamic credit index algorithm, Update the dynamic credit index), Improve the basic mechanism of credit evaluation.

Apps. Accessibility and Usability by People with Visual Disabilities

ERIC Educational Resources Information Center

Olmedo-Moreno, Eva María; López-Delgado, Adrian

2015-01-01

The increasing use of ICT devices, such as smartphones and tablets, needs development of properly software or apps to facilitate socio-educative life of citizens in smart cities: Adaptive educational resources, leisure and entertainment facilities or mobile payment services, among others. Undoubtedly, all that is opening a new age with more…

Expanding co-payment for methadone maintenance services in Vietnam: the importance of addressing health and socioeconomic inequalities.

PubMed

Tran, Bach Xuan; Nguyen, Quyen Le; Nguyen, Long Hoang; Phan, Huong Thu Thi; Le, Huong Thi; Tran, Tho Dinh; Vu, Thuc Thi Minh; Latkin, Carl A

2017-07-12

Ensuring high enrollment while mobilizing resources through co-payment services is critical to the success of the methadone maintenance treatment (MMT) program in Vietnam. This study assessed the willingness of patients to pay (WTP) for different MMT services delivery models and determined its associated factors. A facility based survey was conducted among 1016 MMT patients (98.7% male, 42% aged 35 or less, and 67% living with spouse) in five MMT clinics in Hanoi and Nam Dinh province in 2013. Socioeconomic, HIV and health status, history of drug use and rehabilitation, and MMT experience were interviewed. WTP was assessed using contingent valuation method, including a set of double-bounded binary questions and a follow-up open-ended question. Point and interval data models were used to estimate maximum willingness to pay. 95.5% patients were willing to pay for MMT at the monthly mean price of US$ 32 (95%CI = 28-35). Higher WTP was associated with higher level of educational attainment, higher income, male sex, and had high expenses on opiates prior to MMT. Patients who reported having any problem in Pain/ Discomfort, and who did not have outpatient care last year were willing to pay less for MMT than others. High level of WTP supports the co-payment policies as a strategy to mobilize resources for the MMT program in Vietnam. However, it is necessary to ensure equalities across patient groups by acknowledging socioeconomic status of different settings and providing financial supports for disadvantaged patients with severe health status.

77 FR 54912 - Proposed Agency Information Collection Activities; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2012-09-06

... prepaid card transactions, credit card transactions, mobile payments, and transactions involving third... a remote scanner attached to a PC or point-of-sale device, smartphone or other mobile device, or ATM... mobile payments, including the number and value of relevant bill pay transactions and person-to- person...

Design and implementation of Bluetooth beacon in mobile payment system

NASA Astrophysics Data System (ADS)

Han, Tiantian; Ding, Lei

2017-08-01

The current line of payment means, mainly in the following ways, cash payment, credit card payment, WeChat Alipay sweep payment. There are many inconvenience in Cash payment, large amounts of cash inconvenience to carry, count the money to spend time and effort, true and false banknotes difficult to distinguish, ticket settlement easy to go wrong. Credit card payment is relatively time-consuming, and WeChat Alipay sweep payment need to sweep. Therefore, the design of a convenient, fast payment to meet the line to pay the demand is particularly important. Based on the characteristics of BLE Bluetooth wireless communication technology, this paper designs a kind of payment method based on Bluetooth beacon. Through the Bluetooth beacon broadcast consumption, consumers only need to open the relevant APP in the Android client, and you can get Bluetooth via mobile phone Bluetooth the amount of consumption of the standard broadcast, in accordance with the corresponding payment platform to complete the payment process, which pay less time to improve the efficiency of payment.

42 CFR 414.615 - Transition to the ambulance fee schedule.

Code of Federal Regulations, 2010 CFR

2010-10-01

... inflation factor for ambulance services. (b) 2003 Payment. For services furnished in CY 2003, payment is... inflation factor for ambulance services. (c) 2004 Payment. For services furnished in CY 2004, payment is... inflation factor for ambulance services. (d) 2005 Payment. For services furnished in CY 2005, payment is...

39 CFR 761.8 - Servicing book-entry Postal Service securities; payment of interest, payment at maturity or upon...

Code of Federal Regulations, 2010 CFR

2010-07-01

... 39 Postal Service 1 2010-07-01 2010-07-01 false Servicing book-entry Postal Service securities... POSTAL SERVICE POSTAL SERVICE DEBT OBLIGATIONS; DISBURSEMENT POSTAL MONEY ORDERS BOOK-ENTRY PROCEDURES § 761.8 Servicing book-entry Postal Service securities; payment of interest, payment at maturity or upon...

39 CFR 761.8 - Servicing book-entry Postal Service securities; payment of interest, payment at maturity or upon...

Code of Federal Regulations, 2012 CFR

2012-07-01

... 39 Postal Service 1 2012-07-01 2012-07-01 false Servicing book-entry Postal Service securities... POSTAL SERVICE POSTAL SERVICE DEBT OBLIGATIONS; DISBURSEMENT POSTAL MONEY ORDERS BOOK-ENTRY PROCEDURES § 761.8 Servicing book-entry Postal Service securities; payment of interest, payment at maturity or upon...

39 CFR 761.8 - Servicing book-entry Postal Service securities; payment of interest, payment at maturity or upon...

Code of Federal Regulations, 2014 CFR

2014-07-01

... 39 Postal Service 1 2014-07-01 2014-07-01 false Servicing book-entry Postal Service securities... POSTAL SERVICE POSTAL SERVICE DEBT OBLIGATIONS; DISBURSEMENT POSTAL MONEY ORDERS BOOK-ENTRY PROCEDURES § 761.8 Servicing book-entry Postal Service securities; payment of interest, payment at maturity or upon...

A usability evaluation of Lazada mobile application

NASA Astrophysics Data System (ADS)

Hussain, Azham; Mkpojiogu, Emmanuel O. C.; Jamaludin, Nur Hafiza; Moh, Somia T. L.

2017-10-01

This paper reports on a usability evaluation of Lazada mobile application, an online shopping app for mobile devices. The evaluation was conducted using 12 users of ages 18 to 24. Seven (7) were expert users and the other 5 were novice users. The study objectives were to evaluate the perceived effectiveness, efficiency and satisfaction of the mobile application. The result provides a positive feedback and shows that the mobile shopping app is effective, efficient, and satisfying as perceived by the study participants. However, there are some observed usability issues with the main menu and the payment method that necessitates improvements to increase the application's effectiveness, efficiency and satisfaction. The suggested improvements include: 1) the main menu should be capitalized and place on the left side of mobile app and 2) payment method tutorial should be included as a hyperlink in the payment method page. This observation will be helpful to the owners of the application in future version development of the app.

76 FR 63353 - Proposed Information Collection (Payment and Reimbursement for Emergency Services for Non Service...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-10-12

... (Payment and Reimbursement for Emergency Services for Non Service-Connected Conditions in Non-VA Facilities... to determine a claimant's eligibility for reimbursement or payment for emergency medical treatment at... information technology. Title: Payment and Reimbursement for Emergency Services for Non Service-Connected...

Medicare payments to the neurology workforce in 2012

PubMed Central

Skolarus, Lesli E.; Burke, James F.; Callaghan, Brian C.; Becker, Amanda

2015-01-01

Objective: Little is known about how neurology payments vary by service type (i.e., evaluation and management [E/M] vs tests/treatments) and compare to other specialties, yet this information is necessary to help neurology define its position on proposed payment reform. Methods: Medicare Provider Utilization and Payment Data from 2012 were used. These data included all direct payments to providers who care for fee-for-service Medicare recipients. Total payment was determined by medical specialty and for various services (e.g., E/M, EEG, electromyography/nerve conduction studies, polysomnography) within neurology. Payment and proportion of services were then calculated across neurologists' payment categories. Results: Neurologists comprised 1.5% (12,317) of individual providers who received Medicare payments and were paid $1.15 billion by Medicare in 2012. Sixty percent ($686 million) of the Medicare payment to neurologists was for E/M, which was a lower proportion than primary providers (approximately 85%) and higher than surgical subspecialties (range 9%–51%). The median neurologist received nearly 75% of their payments from E/M. Two-thirds of neurologists received 60% or more of their payment from E/M services and over 20% received all of their payment from E/M services. Neurologists in the highest payment category performed more services, of which a lower proportion were E/M, and performed at a facility, compared to neurologists in lower payment categories. Conclusion: E/M is the dominant source of payment to the majority of neurologists and should be prioritized by neurology in payment restructuring efforts. PMID:25832665

Medicare payments to the neurology workforce in 2012.

PubMed

Skolarus, Lesli E; Burke, James F; Callaghan, Brian C; Becker, Amanda; Kerber, Kevin A

2015-04-28

Little is known about how neurology payments vary by service type (i.e., evaluation and management [E/M] vs tests/treatments) and compare to other specialties, yet this information is necessary to help neurology define its position on proposed payment reform. Medicare Provider Utilization and Payment Data from 2012 were used. These data included all direct payments to providers who care for fee-for-service Medicare recipients. Total payment was determined by medical specialty and for various services (e.g., E/M, EEG, electromyography/nerve conduction studies, polysomnography) within neurology. Payment and proportion of services were then calculated across neurologists' payment categories. Neurologists comprised 1.5% (12,317) of individual providers who received Medicare payments and were paid $1.15 billion by Medicare in 2012. Sixty percent ($686 million) of the Medicare payment to neurologists was for E/M, which was a lower proportion than primary providers (approximately 85%) and higher than surgical subspecialties (range 9%-51%). The median neurologist received nearly 75% of their payments from E/M. Two-thirds of neurologists received 60% or more of their payment from E/M services and over 20% received all of their payment from E/M services. Neurologists in the highest payment category performed more services, of which a lower proportion were E/M, and performed at a facility, compared to neurologists in lower payment categories. E/M is the dominant source of payment to the majority of neurologists and should be prioritized by neurology in payment restructuring efforts. © 2015 American Academy of Neurology.

41 CFR 301-73.301 - How do we obtain travel payment system services?

Code of Federal Regulations, 2010 CFR

2010-07-01

... payment system services? 301-73.301 Section 301-73.301 Public Contracts and Property Management Federal... PROGRAMS Travel Payment System § 301-73.301 How do we obtain travel payment system services? You may participate in GSA's or another Federal agency's travel payment system services program or you may contract...

42 CFR 412.125 - Effect of change of ownership on payments under the prospective payment systems.

Code of Federal Regulations, 2010 CFR

2010-10-01

... prospective payment systems. 412.125 Section 412.125 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Payments to Hospitals Under the Prospective Payment Systems § 412.125 Effect of change of...

42 CFR 412.20 - Hospital services subject to the prospective payment systems.

Code of Federal Regulations, 2010 CFR

2010-10-01

... payment systems. 412.20 Section 412.20 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Hospital Services Subject to and Excluded From the Prospective Payment Systems for Inpatient...

Medicaid program; revision to Medicaid upper payment limit requirements for hospital services, nursing facility services, intermediate care facility services for the mentally retarded, and clinic services. Health Care Financing Administration (HCFA), HHS. Final rule.

PubMed

2001-01-12

This final rule modifies the Medicaid upper payment limits for inpatient hospital services, outpatient hospital services, nursing facility services, intermediate care facility services for the mentally retarded, and clinic services. For each type of Medicaid inpatient service, existing regulations place an upper limit on overall aggregate payments to all facilities and a separate aggregate upper limit on payments made to State-operated facilities. This final rule establishes an aggregate upper limit that applies to payments made to government facilities that are not State government-owned or operated, and a separate aggregate upper limit on payments made to privately-owned and operated facilities. This rule also eliminates the overall aggregate upper limit that had applied to these services. With respect to outpatient hospital and clinic services, this final rule establishes an aggregate upper limit on payments made to State government-owned or operated facilities, an aggregate upper limit on payments made to government facilities that are not State government-owned or operated, and an aggregate upper limit on payments made to privately-owned and operated facilities. These separate upper limits are necessary to ensure State Medicaid payment systems promote economy and efficiency. We are allowing a higher upper limit for payment to non-State public hospitals to recognize the higher costs of inpatient and outpatient services in public hospitals. In addition, to ensure continued beneficiary access to care and the ability of States to adjust to the changes in the upper payment limits, the final rule includes a transition period for States with approved rate enhancement State plan amendments.

20 CFR 404.2116 - When claims for payment for VR services must be made (filing deadlines).

Code of Federal Regulations, 2011 CFR

2011-04-01

... 20 Employees' Benefits 2 2011-04-01 2011-04-01 false When claims for payment for VR services must... Rehabilitation Services Payment Provisions § 404.2116 When claims for payment for VR services must be made (filing deadlines). The State VR agency or alternate participant must file a claim for payment in each...

20 CFR 416.2216 - When claims for payment for VR services must be made (filing deadlines).

Code of Federal Regulations, 2010 CFR

2010-04-01

... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false When claims for payment for VR services must... Rehabilitation Services Payment Provisions § 416.2216 When claims for payment for VR services must be made (filing deadlines). The State VR agency or alternate participant must file a claim for payment in each...

20 CFR 416.2216 - When claims for payment for VR services must be made (filing deadlines).

Code of Federal Regulations, 2011 CFR

2011-04-01

... 20 Employees' Benefits 2 2011-04-01 2011-04-01 false When claims for payment for VR services must... Rehabilitation Services Payment Provisions § 416.2216 When claims for payment for VR services must be made (filing deadlines). The State VR agency or alternate participant must file a claim for payment in each...

20 CFR 404.2116 - When claims for payment for VR services must be made (filing deadlines).

Code of Federal Regulations, 2010 CFR

2010-04-01

... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false When claims for payment for VR services must... Rehabilitation Services Payment Provisions § 404.2116 When claims for payment for VR services must be made (filing deadlines). The State VR agency or alternate participant must file a claim for payment in each...

20 CFR 416.2216 - When claims for payment for VR services must be made (filing deadlines).

Code of Federal Regulations, 2012 CFR

2012-04-01

... 20 Employees' Benefits 2 2012-04-01 2012-04-01 false When claims for payment for VR services must... Rehabilitation Services Payment Provisions § 416.2216 When claims for payment for VR services must be made (filing deadlines). The State VR agency or alternate participant must file a claim for payment in each...

20 CFR 416.2216 - When claims for payment for VR services must be made (filing deadlines).

Code of Federal Regulations, 2014 CFR

2014-04-01

... 20 Employees' Benefits 2 2014-04-01 2014-04-01 false When claims for payment for VR services must... Rehabilitation Services Payment Provisions § 416.2216 When claims for payment for VR services must be made (filing deadlines). The State VR agency or alternate participant must file a claim for payment in each...

20 CFR 404.2116 - When claims for payment for VR services must be made (filing deadlines).

Code of Federal Regulations, 2013 CFR

2013-04-01

... 20 Employees' Benefits 2 2013-04-01 2013-04-01 false When claims for payment for VR services must... Rehabilitation Services Payment Provisions § 404.2116 When claims for payment for VR services must be made (filing deadlines). The State VR agency or alternate participant must file a claim for payment in each...

20 CFR 404.2116 - When claims for payment for VR services must be made (filing deadlines).

Code of Federal Regulations, 2012 CFR

2012-04-01

... 20 Employees' Benefits 2 2012-04-01 2012-04-01 false When claims for payment for VR services must... Rehabilitation Services Payment Provisions § 404.2116 When claims for payment for VR services must be made (filing deadlines). The State VR agency or alternate participant must file a claim for payment in each...

20 CFR 404.2116 - When claims for payment for VR services must be made (filing deadlines).

Code of Federal Regulations, 2014 CFR

2014-04-01

... 20 Employees' Benefits 2 2014-04-01 2014-04-01 false When claims for payment for VR services must... Rehabilitation Services Payment Provisions § 404.2116 When claims for payment for VR services must be made (filing deadlines). The State VR agency or alternate participant must file a claim for payment in each...

20 CFR 416.2216 - When claims for payment for VR services must be made (filing deadlines).

Code of Federal Regulations, 2013 CFR

2013-04-01

... 20 Employees' Benefits 2 2013-04-01 2013-04-01 false When claims for payment for VR services must... Rehabilitation Services Payment Provisions § 416.2216 When claims for payment for VR services must be made (filing deadlines). The State VR agency or alternate participant must file a claim for payment in each...

42 CFR 414.54 - Payment for certified nurse-midwives' services.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 3 2010-10-01 2010-10-01 false Payment for certified nurse-midwives' services. 414... Physicians and Other Practitioners § 414.54 Payment for certified nurse-midwives' services. For services...)(1)(K) of the Act for the payment of certified nurse-midwife services may not exceed 65 percent of...

42 CFR 414.54 - Payment for certified nurse-midwives' services.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 3 2011-10-01 2011-10-01 false Payment for certified nurse-midwives' services. 414... Physicians and Other Practitioners § 414.54 Payment for certified nurse-midwives' services. (a) For services...)(1)(K) of the Act for the payment of certified nurse-midwife services may not exceed 65 percent of...

42 CFR 414.61 - Payment for anesthesia services furnished by a teaching CRNA.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 3 2011-10-01 2011-10-01 false Payment for anesthesia services furnished by a... SERVICES Physicians and Other Practitioners § 414.61 Payment for anesthesia services furnished by a teaching CRNA. (a) Basis for payment. Beginning January 1, 2010, anesthesia services furnished by a...

42 CFR 414.61 - Payment for anesthesia services furnished by a teaching CRNA.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 42 Public Health 3 2013-10-01 2013-10-01 false Payment for anesthesia services furnished by a... HEALTH SERVICES Physicians and Other Practitioners § 414.61 Payment for anesthesia services furnished by a teaching CRNA. (a) Basis for payment. Beginning January 1, 2010, anesthesia services furnished by...

42 CFR 414.61 - Payment for anesthesia services furnished by a teaching CRNA.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 3 2014-10-01 2014-10-01 false Payment for anesthesia services furnished by a... HEALTH SERVICES Physicians and Other Practitioners § 414.61 Payment for anesthesia services furnished by a teaching CRNA. (a) Basis for payment. Beginning January 1, 2010, anesthesia services furnished by...

42 CFR 414.61 - Payment for anesthesia services furnished by a teaching CRNA.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 3 2012-10-01 2012-10-01 false Payment for anesthesia services furnished by a... HEALTH SERVICES Physicians and Other Practitioners § 414.61 Payment for anesthesia services furnished by a teaching CRNA. (a) Basis for payment. Beginning January 1, 2010, anesthesia services furnished by...

20 CFR 404.2112 - Payment for VR services in a case where an individual continues to receive disability payments...

Code of Federal Regulations, 2010 CFR

2010-04-01

... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false Payment for VR services in a case where an individual continues to receive disability payments based on participation in an approved VR program. 404... Payment for VR services in a case where an individual continues to receive disability payments based on...

20 CFR 404.2112 - Payment for VR services in a case where an individual continues to receive disability payments...

Code of Federal Regulations, 2011 CFR

2011-04-01

... 20 Employees' Benefits 2 2011-04-01 2011-04-01 false Payment for VR services in a case where an individual continues to receive disability payments based on participation in an approved VR program. 404... Payment for VR services in a case where an individual continues to receive disability payments based on...

20 CFR 404.2112 - Payment for VR services in a case where an individual continues to receive disability payments...

Code of Federal Regulations, 2013 CFR

2013-04-01

... 20 Employees' Benefits 2 2013-04-01 2013-04-01 false Payment for VR services in a case where an individual continues to receive disability payments based on participation in an approved VR program. 404... Payment for VR services in a case where an individual continues to receive disability payments based on...

20 CFR 404.2112 - Payment for VR services in a case where an individual continues to receive disability payments...

Code of Federal Regulations, 2012 CFR

2012-04-01

... 20 Employees' Benefits 2 2012-04-01 2012-04-01 false Payment for VR services in a case where an individual continues to receive disability payments based on participation in an approved VR program. 404... Payment for VR services in a case where an individual continues to receive disability payments based on...

20 CFR 404.2112 - Payment for VR services in a case where an individual continues to receive disability payments...

Code of Federal Regulations, 2014 CFR

2014-04-01

... 20 Employees' Benefits 2 2014-04-01 2014-04-01 false Payment for VR services in a case where an individual continues to receive disability payments based on participation in an approved VR program. 404... Payment for VR services in a case where an individual continues to receive disability payments based on...

42 CFR 412.87 - Additional payment for new medical services and technologies: General provisions.

Code of Federal Regulations, 2011 CFR

2011-10-01

... technologies: General provisions. 412.87 Section 412.87 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES... SERVICES Payments for Outlier Cases, Special Treatment Payment for New Technology, and Payment Adjustment for Certain Replaced Devices Additional Special Payment for Certain New Technology § 412.87 Additional...

42 CFR 412.87 - Additional payment for new medical services and technologies: General provisions.

Code of Federal Regulations, 2013 CFR

2013-10-01

... technologies: General provisions. 412.87 Section 412.87 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES... SERVICES Payments for Outlier Cases, Special Treatment Payment for New Technology, and Payment Adjustment for Certain Replaced Devices Additional Special Payment for Certain New Technology § 412.87 Additional...

42 CFR 412.87 - Additional payment for new medical services and technologies: General provisions.

Code of Federal Regulations, 2012 CFR

2012-10-01

... technologies: General provisions. 412.87 Section 412.87 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES... SERVICES Payments for Outlier Cases, Special Treatment Payment for New Technology, and Payment Adjustment for Certain Replaced Devices Additional Special Payment for Certain New Technology § 412.87 Additional...

42 CFR 412.87 - Additional payment for new medical services and technologies: General provisions.

Code of Federal Regulations, 2010 CFR

2010-10-01

... technologies: General provisions. 412.87 Section 412.87 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES... SERVICES Payments for Outlier Cases, Special Treatment Payment for New Technology, and Payment Adjustment for Certain Replaced Devices Additional Special Payment for Certain New Technology § 412.87 Additional...

42 CFR 412.540 - Method of payment for preadmission services under the long-term care hospital prospective payment...

Code of Federal Regulations, 2010 CFR

2010-10-01

... the long-term care hospital prospective payment system. 412.540 Section 412.540 Public Health CENTERS... PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Prospective Payment System for Long-Term Care Hospitals... payment system. The prospective payment system includes payment for inpatient operating costs of...

20 CFR 416.2214 - Services for which payment may be made.

Code of Federal Regulations, 2010 CFR

2010-04-01

... § 416.2214 Services for which payment may be made. (a) General. Payment may be made for VR services provided by a State VR agency in accordance with title I of the Rehabilitation Act of 1973, as amended, or... this subpart. VR services for which payment may be made under this subpart include only those services...

20 CFR 416.2214 - Services for which payment may be made.

Code of Federal Regulations, 2011 CFR

2011-04-01

... § 416.2214 Services for which payment may be made. (a) General. Payment may be made for VR services provided by a State VR agency in accordance with title I of the Rehabilitation Act of 1973, as amended, or... this subpart. VR services for which payment may be made under this subpart include only those services...

42 CFR 410.165 - Payment for rural health clinic services and ambulatory surgical center services: Conditions.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 2 2010-10-01 2010-10-01 false Payment for rural health clinic services and... (SMI) BENEFITS Payment of SMI Benefits § 410.165 Payment for rural health clinic services and ambulatory surgical center services: Conditions. (a) Medicare Part B pays for covered rural health clinic and...

20 CFR 416.2214 - Services for which payment may be made.

Code of Federal Regulations, 2014 CFR

2014-04-01

... § 416.2214 Services for which payment may be made. (a) General. Payment may be made for VR services provided by a State VR agency in accordance with title I of the Rehabilitation Act of 1973, as amended, or... this subpart. VR services for which payment may be made under this subpart include only those services...

20 CFR 416.2214 - Services for which payment may be made.

Code of Federal Regulations, 2012 CFR

2012-04-01

... § 416.2214 Services for which payment may be made. (a) General. Payment may be made for VR services provided by a State VR agency in accordance with title I of the Rehabilitation Act of 1973, as amended, or... this subpart. VR services for which payment may be made under this subpart include only those services...

20 CFR 416.2214 - Services for which payment may be made.

Code of Federal Regulations, 2013 CFR

2013-04-01

... § 416.2214 Services for which payment may be made. (a) General. Payment may be made for VR services provided by a State VR agency in accordance with title I of the Rehabilitation Act of 1973, as amended, or... this subpart. VR services for which payment may be made under this subpart include only those services...

42 CFR 412.6 - Cost reporting periods subject to the prospective payment systems.

Code of Federal Regulations, 2010 CFR

2010-10-01

... payment systems. 412.6 Section 412.6 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES... prospective payment system for inpatient operating costs, the reasonable costs of services furnished before...

42 CFR 416.171 - Determination of payment rates for ASC services.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 3 2010-10-01 2010-10-01 false Determination of payment rates for ASC services... Determination of payment rates for ASC services. (a) Standard methodology. The standard methodology for determining the national unadjusted payment rate for ASC services is to calculate the product of the...

42 CFR 403.770 - Payments for home services.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 42 Public Health 2 2013-10-01 2013-10-01 false Payments for home services. 403.770 Section 403.770... of Participation, and Payment § 403.770 Payments for home services. (a) The RNHCI nursing visits are paid at the modified low utilization payment adjusted (LUPA) rate used under the home health...

42 CFR 403.770 - Payments for home services.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 2 2010-10-01 2010-10-01 false Payments for home services. 403.770 Section 403.770... of Participation, and Payment § 403.770 Payments for home services. (a) The RNHCI nursing visits are paid at the modified low utilization payment adjusted (LUPA) rate used under the home health...

42 CFR 403.770 - Payments for home services.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 2 2014-10-01 2014-10-01 false Payments for home services. 403.770 Section 403.770... of Participation, and Payment § 403.770 Payments for home services. (a) The RNHCI nursing visits are paid at the modified low utilization payment adjusted (LUPA) rate used under the home health...

42 CFR 403.770 - Payments for home services.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 2 2011-10-01 2011-10-01 false Payments for home services. 403.770 Section 403.770... of Participation, and Payment § 403.770 Payments for home services. (a) The RNHCI nursing visits are paid at the modified low utilization payment adjusted (LUPA) rate used under the home health...

42 CFR 403.770 - Payments for home services.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 2 2012-10-01 2012-10-01 false Payments for home services. 403.770 Section 403.770... of Participation, and Payment § 403.770 Payments for home services. (a) The RNHCI nursing visits are paid at the modified low utilization payment adjusted (LUPA) rate used under the home health...

Fee-for-service will remain a feature of major payment reforms, requiring more changes in Medicare physician payment.

PubMed

Ginsburg, Paul B

2012-09-01

Many health policy analysts envision provider payment reforms currently under development as replacements for the traditional fee-for-service payment system. Reforms include per episode bundled payment and elements of capitation, such as global payments or accountable care organizations. But even if these approaches succeed and are widely adopted, the core method of payment to many physicians for the services they provide is likely to remain fee-for-service. It is therefore critical to address the current shortcomings in the Medicare physician fee schedule, because it will affect physician incentives and will continue to play an important role in determining the payment amounts under payment reform. This article reviews how the current payment system developed and is applied, and it highlights areas that require careful review and modification to ensure the success of broader payment reform.

38 CFR 17.111 - Copayments for extended care services.

Code of Federal Regulations, 2010 CFR

2010-07-01

... payments, black lung payments, tort settlement payments, social security payments, court mandated payments... or services authorized under 38 U.S.C. 1720E for certain veterans regarding cancer of the head or...

7 CFR 4288.134 - Refunds and interest payments.

Code of Federal Regulations, 2014 CFR

2014-01-01

... SERVICE AND RURAL UTILITIES SERVICE, DEPARTMENT OF AGRICULTURE PAYMENT PROGRAMS Advanced Biofuel Payment... advanced biofuel producer who receives payments under this subpart may be required to refund such payments... General for appropriate action. (a) An eligible advanced biofuel producer receiving payments under this...

42 CFR 413.217 - Items and services included in the ESRD prospective payment system.

Code of Federal Regulations, 2010 CFR

2010-10-01

... payment system. 413.217 Section 413.217 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT....217 Items and services included in the ESRD prospective payment system. The following items and services are included in the ESRD prospective payment system effective January 1, 2011: (a) Renal dialysis...

42 CFR § 510.325 - Allocation of payments for services that straddle the episode.

Code of Federal Regulations, 2010 CFR

2016-10-01

..., DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) HEALTH CARE INFRASTRUCTURE AND MODEL PROGRAMS COMPREHENSIVE CARE FOR JOINT REPLACEMENT MODEL Pricing and Payment § 510.325 Allocation of payments for services... 42 Public Health 5 2016-10-01 2016-10-01 false Allocation of payments for services that straddle...

42 CFR § 510.325 - Allocation of payments for services that straddle the episode.

Code of Federal Regulations, 2010 CFR

2017-10-01

..., DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) HEALTH CARE INFRASTRUCTURE AND MODEL PROGRAMS COMPREHENSIVE CARE FOR JOINT REPLACEMENT MODEL Pricing and Payment § 510.325 Allocation of payments for services... 42 Public Health 5 2017-10-01 2017-10-01 false Allocation of payments for services that straddle...

42 CFR 412.505 - Conditions for payment under the prospective payment system for long-term care hospitals.

Code of Federal Regulations, 2010 CFR

2010-10-01

... payment system for long-term care hospitals. 412.505 Section 412.505 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Prospective Payment System for Long-Term Care Hospitals § 412.505 Conditions for...

42 CFR 415.110 - Conditions for payment: Medically directed anesthesia services.

Code of Federal Regulations, 2012 CFR

2012-10-01

... anesthesia services. 415.110 Section 415.110 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES... payment: Medically directed anesthesia services. (a) General payment rule. Medicare pays for the physician's medical direction of anesthesia services for one service or two through four concurrent anesthesia...

42 CFR 415.110 - Conditions for payment: Medically directed anesthesia services.

Code of Federal Regulations, 2014 CFR

2014-10-01

... anesthesia services. 415.110 Section 415.110 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES... payment: Medically directed anesthesia services. (a) General payment rule. Medicare pays for the physician's medical direction of anesthesia services for one service or two through four concurrent anesthesia...

42 CFR 415.110 - Conditions for payment: Medically directed anesthesia services.

Code of Federal Regulations, 2013 CFR

2013-10-01

... anesthesia services. 415.110 Section 415.110 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES... payment: Medically directed anesthesia services. (a) General payment rule. Medicare pays for the physician's medical direction of anesthesia services for one service or two through four concurrent anesthesia...

12 CFR Appendix A to Part 235 - Official Board Commentary on Regulation II

Code of Federal Regulations, 2013 CFR

2013-01-01

.... Similarly, the term “debit card” includes a device with a chip or other embedded mechanism, such as a mobile... mobile phone) that stores several different payment codes or devices (“virtual cards”) that access... transactions, a cash withdrawal from an ATM is not a payment because there is no exchange of money for goods or...

12 CFR Appendix A to Part 235 - Official Board Commentary on Regulation II

Code of Federal Regulations, 2014 CFR

2014-01-01

.... Similarly, the term “debit card” includes a device with a chip or other embedded mechanism, such as a mobile... mobile phone) that stores several different payment codes or devices (“virtual cards”) that access... transactions, a cash withdrawal from an ATM is not a payment because there is no exchange of money for goods or...

12 CFR Appendix A to Part 235 - Official Board Commentary on Regulation II

Code of Federal Regulations, 2012 CFR

2012-01-01

.... Similarly, the term “debit card” includes a device with a chip or other embedded mechanism, such as a mobile... mobile phone) that stores several different payment codes or devices (“virtual cards”) that access... transactions, a cash withdrawal from an ATM is not a payment because there is no exchange of money for goods or...

Greening academia: use and disposal of mobile phones among university students.

PubMed

Ongondo, F O; Williams, I D

2011-07-01

Mobile phones have relatively short lifecycles and are rapidly seen as obsolete by many users within little over a year. However, the reusability of these devices as well as their material composition means that in terms of mass and volume, mobile phones represent the most valuable electronic products that are currently found in large numbers in waste streams. End-of-life mobile phones are a high value (from a reuse and resource perspective), high volume (quantity), low cost (residual monetary value) and transient (short lifecycle) electronic product. There are very large numbers of higher education (mainly university) students in the world--there are>2.4 million in the UK alone, 19 million in Europe and 18.2 million in the USA--and they often replace their mobile phones several times before graduation. Thus, because of the potentially significant environmental and economic impacts, a large scale survey of students at 5 UK universities was conducted to assess the behaviour of students with regard to their use and disposal of mobile phones. Additionally, a small scale trial mobile phone takeback service at one of the universities was carried out. The findings indicate that many students replace their phones at least once a year; replacing broken phones, getting upgrades from network operators, remaining "fashionable" and a desire to have a handset with a longer battery life are the main reasons for such rapid replacement. Almost 60% of replaced phones are not sent to reuse or recycling operations but are stockpiled by students mainly as spare/backup phones. Approximately 61% of students own an extra mobile phone with male students replacing their phones more often than females. In particular, the results highlight the potentially huge stockpile of mobile phones--and consequently valuable supplies of rare metals--being held by the public; we estimate that there are 3.7 million phones stockpiled by students in UK higher education alone (29.3 and 28.1 million stockpiled, respectively, for Europe and USA). Although many students are aware of UK mobile phone takeback services, only a moderate number have previously used the services. Students' recycling of other waste materials such as paper and glass did not have a significant impact on their disposal actions for their unwanted mobile phones, although students who often recycled these waste materials were also the most willing to participate in mobile phone takeback services. Monetary incentives such as cash payments and vouchers have the greatest influence over students' willingness to utilise takeback services, followed by convenience and ease of use of the services. The paper discusses these findings as well as the outcome of the trial mobile phone takeback. It is suggested that universities should partner with established takeback operators to conduct event-based mobile phone takeback services primarily targeting students. Lessons from mobile phone takeback applicable to takeback services for end-of-life gadgets similar to mobile phones are also discussed. Copyright © 2011 Elsevier Ltd. All rights reserved.

42 CFR 412.80 - Outlier cases: General provisions.

Code of Federal Regulations, 2011 CFR

2011-10-01

..., Special Treatment Payment for New Technology, and Payment Adjustment for Certain Replaced Devices Payment... payments and beyond additional payments for new medical services or technology specified in §§ 412.87 and... share of low-income patients (§ 412.106), and additional payments for new medical services or...

42 CFR 412.88 - Additional payment for new medical service or technology.

Code of Federal Regulations, 2012 CFR

2012-10-01

... technology. 412.88 Section 412.88 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF... Payments for Outlier Cases, Special Treatment Payment for New Technology, and Payment Adjustment for Certain Replaced Devices Additional Special Payment for Certain New Technology § 412.88 Additional payment...

42 CFR 412.88 - Additional payment for new medical service or technology.

Code of Federal Regulations, 2013 CFR

2013-10-01

... technology. 412.88 Section 412.88 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF... Payments for Outlier Cases, Special Treatment Payment for New Technology, and Payment Adjustment for Certain Replaced Devices Additional Special Payment for Certain New Technology § 412.88 Additional payment...

42 CFR 412.88 - Additional payment for new medical service or technology.

Code of Federal Regulations, 2011 CFR

2011-10-01

... technology. 412.88 Section 412.88 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF... Payments for Outlier Cases, Special Treatment Payment for New Technology, and Payment Adjustment for Certain Replaced Devices Additional Special Payment for Certain New Technology § 412.88 Additional payment...

42 CFR 412.88 - Additional payment for new medical service or technology.

Code of Federal Regulations, 2010 CFR

2010-10-01

... technology. 412.88 Section 412.88 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF... Payments for Outlier Cases, Special Treatment Payment for New Technology, and Payment Adjustment for Certain Replaced Devices Additional Special Payment for Certain New Technology § 412.88 Additional payment...

47 CFR 54.514 - Payment for discounted service.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 47 Telecommunication 3 2012-10-01 2012-10-01 false Payment for discounted service. 54.514 Section 54.514 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) COMMON CARRIER SERVICES (CONTINUED) UNIVERSAL SERVICE Universal Service Support for Schools and Libraries § 54.514 Payment for...

47 CFR 54.514 - Payment for discounted service.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 47 Telecommunication 3 2011-10-01 2011-10-01 false Payment for discounted service. 54.514 Section 54.514 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) COMMON CARRIER SERVICES (CONTINUED) UNIVERSAL SERVICE Universal Service Support for Schools and Libraries § 54.514 Payment for...

42 CFR 415.120 - Conditions for payment: Radiology services.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 3 2010-10-01 2010-10-01 false Conditions for payment: Radiology services. 415.120... Services to Beneficiaries in Providers § 415.120 Conditions for payment: Radiology services. (a) Services to beneficiaries. The carrier pays for radiology services furnished by a physician to a beneficiary...

7 CFR 4288.134 - Refunds and interest payments.

Code of Federal Regulations, 2012 CFR

2012-01-01

... SERVICE AND RURAL UTILITIES SERVICE, DEPARTMENT OF AGRICULTURE PAYMENT PROGRAMS Advanced Biofuel Payment Program General Provisions § 4288.134 Refunds and interest payments. An eligible advanced biofuel producer...) An eligible advanced biofuel producer receiving payments under this subpart shall become ineligible...

7 CFR 4288.134 - Refunds and interest payments.

Code of Federal Regulations, 2013 CFR

2013-01-01

... SERVICE AND RURAL UTILITIES SERVICE, DEPARTMENT OF AGRICULTURE PAYMENT PROGRAMS Advanced Biofuel Payment Program General Provisions § 4288.134 Refunds and interest payments. An eligible advanced biofuel producer...) An eligible advanced biofuel producer receiving payments under this subpart shall become ineligible...

42 CFR 414.707 - Basis of payment.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 3 2011-10-01 2011-10-01 false Basis of payment. 414.707 Section 414.707 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM PAYMENT FOR PART B MEDICAL AND OTHER HEALTH SERVICES Payment for Drugs and Biologicals...

42 CFR 414.707 - Basis of payment.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 3 2010-10-01 2010-10-01 false Basis of payment. 414.707 Section 414.707 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM PAYMENT FOR PART B MEDICAL AND OTHER HEALTH SERVICES Payment for Drugs and Biologicals...

42 CFR 412.101 - Special treatment: Inpatient hospital payment adjustment for low-volume hospitals.

Code of Federal Regulations, 2010 CFR

2010-10-01

... SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Special Treatment of Certain Facilities Under the Prospective Payment System for... 42 Public Health 2 2010-10-01 2010-10-01 false Special treatment: Inpatient hospital payment...

42 CFR 413.210 - Conditions for payment under the end-stage renal disease (ESRD) prospective payment system.

Code of Federal Regulations, 2011 CFR

2011-10-01

... disease (ESRD) prospective payment system. 413.210 Section 413.210 Public Health CENTERS FOR MEDICARE... REIMBURSEMENT; PAYMENT FOR END-STAGE RENAL DISEASE SERVICES; OPTIONAL PROSPECTIVELY DETERMINED PAYMENT RATES FOR SKILLED NURSING FACILITIES Payment for End-Stage Renal Disease (ESRD) Services and Organ Procurement Costs...

42 CFR 413.210 - Conditions for payment under the end-stage renal disease (ESRD) prospective payment system.

Code of Federal Regulations, 2010 CFR

2010-10-01

... disease (ESRD) prospective payment system. 413.210 Section 413.210 Public Health CENTERS FOR MEDICARE... REIMBURSEMENT; PAYMENT FOR END-STAGE RENAL DISEASE SERVICES; OPTIONAL PROSPECTIVELY DETERMINED PAYMENT RATES FOR SKILLED NURSING FACILITIES Payment for End-Stage Renal Disease (ESRD) Services and Organ Procurement Costs...

42 CFR 413.210 - Conditions for payment under the end-stage renal disease (ESRD) prospective payment system.

Code of Federal Regulations, 2012 CFR

2012-10-01

... disease (ESRD) prospective payment system. 413.210 Section 413.210 Public Health CENTERS FOR MEDICARE... REIMBURSEMENT; PAYMENT FOR END-STAGE RENAL DISEASE SERVICES; OPTIONAL PROSPECTIVELY DETERMINED PAYMENT RATES FOR SKILLED NURSING FACILITIES Payment for End-Stage Renal Disease (ESRD) Services and Organ Procurement Costs...

42 CFR 413.210 - Conditions for payment under the end-stage renal disease (ESRD) prospective payment system.

Code of Federal Regulations, 2013 CFR

2013-10-01

... disease (ESRD) prospective payment system. 413.210 Section 413.210 Public Health CENTERS FOR MEDICARE... REIMBURSEMENT; PAYMENT FOR END-STAGE RENAL DISEASE SERVICES; OPTIONAL PROSPECTIVELY DETERMINED PAYMENT RATES FOR SKILLED NURSING FACILITIES Payment for End-Stage Renal Disease (ESRD) Services and Organ Procurement Costs...

42 CFR 413.210 - Conditions for payment under the end-stage renal disease (ESRD) prospective payment system.

Code of Federal Regulations, 2014 CFR

2014-10-01

... disease (ESRD) prospective payment system. 413.210 Section 413.210 Public Health CENTERS FOR MEDICARE... REIMBURSEMENT; PAYMENT FOR END-STAGE RENAL DISEASE SERVICES; OPTIONAL PROSPECTIVELY DETERMINED PAYMENT RATES FOR SKILLED NURSING FACILITIES Payment for End-Stage Renal Disease (ESRD) Services and Organ Procurement Costs...

42 CFR 412.112 - Payments determined on a per case basis.

Code of Federal Regulations, 2010 CFR

2010-10-01

... SERVICES MEDICARE PROGRAM PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Payments to Hospitals Under the Prospective Payment Systems § 412.112 Payments determined on a per case basis. A hospital is... 42 Public Health 2 2010-10-01 2010-10-01 false Payments determined on a per case basis. 412.112...

Greening academia: Use and disposal of mobile phones among university students

DOE Office of Scientific and Technical Information (OSTI.GOV)

Ongondo, F.O.; Williams, I.D., E-mail: idw@soton.ac.uk

Research highlights: > Students use/disposal of mobile phones was assessed via a large-scale survey and a takeback trial. > We estimate 3.7 m phones stockpiled by UK students; 29.3 and 28.1 m stockpiled for Europe and USA. > Many students replace phones at least once a year; only a small number have used a takeback service. > Monetary incentives have greatest influence over willingness to utilise takeback services. > Universities should partner with established operators to conduct targeted takeback services. - Abstract: Mobile phones have relatively short lifecycles and are rapidly seen as obsolete by many users within little overmore » a year. However, the reusability of these devices as well as their material composition means that in terms of mass and volume, mobile phones represent the most valuable electronic products that are currently found in large numbers in waste streams. End-of-life mobile phones are a high value (from a reuse and resource perspective), high volume (quantity), low cost (residual monetary value) and transient (short lifecycle) electronic product. There are very large numbers of higher education (mainly university) students in the world - there are >2.4 million in the UK alone, 19 million in Europe and 18.2 million in the USA - and they often replace their mobile phones several times before graduation. Thus, because of the potentially significant environmental and economic impacts, a large scale survey of students at 5 UK universities was conducted to assess the behaviour of students with regard to their use and disposal of mobile phones. Additionally, a small scale trial mobile phone takeback service at one of the universities was carried out. The findings indicate that many students replace their phones at least once a year; replacing broken phones, getting upgrades from network operators, remaining 'fashionable' and a desire to have a handset with a longer battery life are the main reasons for such rapid replacement. Almost 60% of replaced phones are not sent to reuse or recycling operations but are stockpiled by students mainly as spare/backup phones. Approximately 61% of students own an extra mobile phone with male students replacing their phones more often than females. In particular, the results highlight the potentially huge stockpile of mobile phones - and consequently valuable supplies of rare metals - being held by the public; we estimate that there are 3.7 million phones stockpiled by students in UK higher education alone (29.3 and 28.1 million stockpiled, respectively, for Europe and USA). Although many students are aware of UK mobile phone takeback services, only a moderate number have previously used the services. Students' recycling of other waste materials such as paper and glass did not have a significant impact on their disposal actions for their unwanted mobile phones, although students who often recycled these waste materials were also the most willing to participate in mobile phone takeback services. Monetary incentives such as cash payments and vouchers have the greatest influence over students' willingness to utilise takeback services, followed by convenience and ease of use of the services. The paper discusses these findings as well as the outcome of the trial mobile phone takeback. It is suggested that universities should partner with established takeback operators to conduct event-based mobile phone takeback services primarily targeting students. Lessons from mobile phone takeback applicable to takeback services for end-of-life gadgets similar to mobile phones are also discussed.« less

42 CFR 415.55 - General payment rules.

Code of Federal Regulations, 2012 CFR

2012-10-01

... availability services, except for reasonable availability services furnished for emergency rooms and the... Physician Services § 415.55 General payment rules. (a) Allowable costs. Except as specified otherwise in... physician compensation costs), and 415.162 (concerning payment for physician services furnished to...

42 CFR 415.55 - General payment rules.

Code of Federal Regulations, 2014 CFR

2014-10-01

... availability services, except for reasonable availability services furnished for emergency rooms and the... Physician Services § 415.55 General payment rules. (a) Allowable costs. Except as specified otherwise in... physician compensation costs), and 415.162 (concerning payment for physician services furnished to...

42 CFR 415.55 - General payment rules.

Code of Federal Regulations, 2013 CFR

2013-10-01

... availability services, except for reasonable availability services furnished for emergency rooms and the... Physician Services § 415.55 General payment rules. (a) Allowable costs. Except as specified otherwise in... physician compensation costs), and 415.162 (concerning payment for physician services furnished to...

42 CFR 412.300 - Scope of subpart and definition.

Code of Federal Regulations, 2010 CFR

2010-10-01

... SERVICES MEDICARE PROGRAM PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Prospective Payment... payment system for inpatient hospital capital-related costs. Under this system, payment is made on the... hospitals subject to the prospective payment system under subpart B of this part. (b) Definition. For...

39 CFR 601.110 - Payment of claims.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 39 Postal Service 1 2011-07-01 2011-07-01 false Payment of claims. 601.110 Section 601.110 Postal Service UNITED STATES POSTAL SERVICE PROCUREMENT SYSTEM FOR THE U.S. POSTAL SERVICE: INTELLECTUAL PROPERTY RIGHTS OTHER THAN PATENTS PURCHASING OF PROPERTY AND SERVICES § 601.110 Payment of claims. Any claim...

42 CFR 405.2462 - Payment for rural health clinic and Federally qualified health center services.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 2 2010-10-01 2010-10-01 false Payment for rural health clinic and Federally... AND DISABLED Rural Health Clinic and Federally Qualified Health Center Services Payment for Rural Health Clinic and Federally Qualified Health Center Services § 405.2462 Payment for rural health clinic...

42 CFR § 414.1460 - Monitoring and program integrity.

Code of Federal Regulations, 2010 CFR

2017-10-01

... SERVICES (CONTINUED) MEDICARE PROGRAM (CONTINUED) PAYMENT FOR PART B MEDICAL AND OTHER HEALTH SERVICES Merit-Based Incentive Payment System and Alternative Payment Model Incentive § 414.1460 Monitoring and program integrity. (a) Vetting eligible clinicians prior to payment of the APM Incentive Payment. Prior to...

Medicare's bundling pilot: including post-acute care services.

PubMed

Dummit, Laura A

2011-03-28

Fee-for-service Medicare, in which a separate payment is made for each service, rewards health care providers for delivering more services, but not necessarily coordinating those services over time or across settings. To help address these concerns, the Patient Protection and Affordable Care Act of 2010 requires Medicare to experiment with making a bundled payment for a hospitalization plus post-acute care, that is, the recuperative or rehabilitative care following a hospital discharge. This bundled payment approach is intended to promote more efficient care across the acute/post-acute episode because the entity that receives the payment has financial incentives to keep episode costs below the payment. Although the entity is expected to control costs through improved care coordination and efficiency, it could stint on care or avoid expensive patients instead. This issue brief focuses on the unique challenges posed by the inclusion of post-acute care services in a payment bundle and special considerations in implementing and evaluating the episode payment approach.

77 FR 40148 - Proposed Collection of Information: ACH Vendor/Miscellaneous Payment Enrollment Form

Federal Register 2010, 2011, 2012, 2013, 2014

2012-07-06

.../Miscellaneous Payment Enrollment Form AGENCY: Financial Management Service, Fiscal Service, Treasury. ACTION: Notice and request for comments. SUMMARY: The Financial Management Service, as part of its continuing... Financial Management Service solicits comments concerning the SF 3881 ``ACH Vendor/Miscellaneous Payment...

42 CFR 415.130 - Conditions for payment: Physician pathology services.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 3 2011-10-01 2011-10-01 false Conditions for payment: Physician pathology... Physician Services to Beneficiaries in Providers § 415.130 Conditions for payment: Physician pathology... of physician pathology services to fee-for-service Medicare beneficiaries who were hospital...

42 CFR § 414.1375 - Advancing care information performance category.

Code of Federal Regulations, 2010 CFR

2017-10-01

... HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM (CONTINUED) PAYMENT FOR PART B MEDICAL AND OTHER HEALTH SERVICES Merit-Based Incentive Payment System and Alternative Payment Model Incentive § 414.1375... final score for MIPS payment year 2019 and each MIPS payment year thereafter. (b) Reporting for the...

42 CFR 412.432 - Method of payment under the inpatient psychiatric facility prospective payment system.

Code of Federal Regulations, 2010 CFR

2010-10-01

... SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM PROSPECTIVE PAYMENT SYSTEMS FOR... inpatient psychiatric facility receives payment under this subpart for inpatient operating cost and capital-related costs for each inpatient stay following submission of a bill. (b) Periodic interim payments (PIP...

42 CFR 414.56 - Payment for nurse practitioners' and clinical nurse specialists' services.

Code of Federal Regulations, 2014 CFR

2014-10-01

... the service. For assistant-at-surgery services, allowed amounts for the services of a nurse... 42 Public Health 3 2014-10-01 2014-10-01 false Payment for nurse practitioners' and clinical nurse... AND OTHER HEALTH SERVICES Physicians and Other Practitioners § 414.56 Payment for nurse practitioners...

42 CFR 414.56 - Payment for nurse practitioners' and clinical nurse specialists' services.

Code of Federal Regulations, 2012 CFR

2012-10-01

... the service. For assistant-at-surgery services, allowed amounts for the services of a nurse... 42 Public Health 3 2012-10-01 2012-10-01 false Payment for nurse practitioners' and clinical nurse... AND OTHER HEALTH SERVICES Physicians and Other Practitioners § 414.56 Payment for nurse practitioners...

42 CFR 414.56 - Payment for nurse practitioners' and clinical nurse specialists' services.

Code of Federal Regulations, 2013 CFR

2013-10-01

... the service. For assistant-at-surgery services, allowed amounts for the services of a nurse... 42 Public Health 3 2013-10-01 2013-10-01 false Payment for nurse practitioners' and clinical nurse... AND OTHER HEALTH SERVICES Physicians and Other Practitioners § 414.56 Payment for nurse practitioners...

42 CFR 414.56 - Payment for nurse practitioners' and clinical nurse specialists' services.

Code of Federal Regulations, 2011 CFR

2011-10-01

... the service. For assistant-at-surgery services, allowed amounts for the services of a nurse... 42 Public Health 3 2011-10-01 2011-10-01 false Payment for nurse practitioners' and clinical nurse... HEALTH SERVICES Physicians and Other Practitioners § 414.56 Payment for nurse practitioners' and clinical...

20 CFR 404.2108 - Requirements for payment.

Code of Federal Regulations, 2011 CFR

2011-04-01

... Requirements for payment. (a) The State VR agency or alternate participant must file a claim for payment in... provided; (2) When the service was provided; and (3) The cost of the service; (c) The VR services for which payment is being requested must have been provided during the period specified in § 404.2115; (d) The VR...

20 CFR 416.2208 - Requirements for payment.

Code of Federal Regulations, 2010 CFR

2010-04-01

... Requirements for payment. (a) The State VR agency or alternate participant must file a claim for payment in... provided; (2) When the service was provided; and (3) The cost of the service; (c) The VR services for which payment is being requested must have been provided during the period specified in § 416.2215; (d) The VR...

20 CFR 416.2208 - Requirements for payment.

Code of Federal Regulations, 2011 CFR

2011-04-01

... Requirements for payment. (a) The State VR agency or alternate participant must file a claim for payment in... provided; (2) When the service was provided; and (3) The cost of the service; (c) The VR services for which payment is being requested must have been provided during the period specified in § 416.2215; (d) The VR...

20 CFR 404.2108 - Requirements for payment.

Code of Federal Regulations, 2010 CFR

2010-04-01

... Requirements for payment. (a) The State VR agency or alternate participant must file a claim for payment in... provided; (2) When the service was provided; and (3) The cost of the service; (c) The VR services for which payment is being requested must have been provided during the period specified in § 404.2115; (d) The VR...

20 CFR 416.2208 - Requirements for payment.

Code of Federal Regulations, 2012 CFR

2012-04-01

... Requirements for payment. (a) The State VR agency or alternate participant must file a claim for payment in... provided; (2) When the service was provided; and (3) The cost of the service; (c) The VR services for which payment is being requested must have been provided during the period specified in § 416.2215; (d) The VR...

20 CFR 416.2208 - Requirements for payment.

Code of Federal Regulations, 2013 CFR

2013-04-01

... Requirements for payment. (a) The State VR agency or alternate participant must file a claim for payment in... provided; (2) When the service was provided; and (3) The cost of the service; (c) The VR services for which payment is being requested must have been provided during the period specified in § 416.2215; (d) The VR...

20 CFR 404.2108 - Requirements for payment.

Code of Federal Regulations, 2014 CFR

2014-04-01

... Requirements for payment. (a) The State VR agency or alternate participant must file a claim for payment in... provided; (2) When the service was provided; and (3) The cost of the service; (c) The VR services for which payment is being requested must have been provided during the period specified in § 404.2115; (d) The VR...

20 CFR 404.2108 - Requirements for payment.

Code of Federal Regulations, 2013 CFR

2013-04-01

... Requirements for payment. (a) The State VR agency or alternate participant must file a claim for payment in... provided; (2) When the service was provided; and (3) The cost of the service; (c) The VR services for which payment is being requested must have been provided during the period specified in § 404.2115; (d) The VR...

20 CFR 404.2108 - Requirements for payment.

Code of Federal Regulations, 2012 CFR

2012-04-01

... Requirements for payment. (a) The State VR agency or alternate participant must file a claim for payment in... provided; (2) When the service was provided; and (3) The cost of the service; (c) The VR services for which payment is being requested must have been provided during the period specified in § 404.2115; (d) The VR...

20 CFR 416.2208 - Requirements for payment.

Code of Federal Regulations, 2014 CFR

2014-04-01

... Requirements for payment. (a) The State VR agency or alternate participant must file a claim for payment in... provided; (2) When the service was provided; and (3) The cost of the service; (c) The VR services for which payment is being requested must have been provided during the period specified in § 416.2215; (d) The VR...

77 FR 15605 - Mobile Commerce and Personalization Promotion

Federal Register 2010, 2011, 2012, 2013, 2014

2012-03-16

... automation mailings. Postage Payment Methods Postage payment methods will be restricted to permit imprint.... 2. Standard Mail (including Nonprofit) letters or flats. d. Postage must be paid by permit imprint...

78 FR 73104 - Federal Travel Regulation (FTR); Agency Requirements for Payment of Expenses Connected With the...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-12-05

... for Payment of Expenses Connected With the Death of Certain Employees and Family Members AGENCY... requirements for payment of expenses connected with the death of certain employees and family members. This... employee whose death occurred while away from the official station on a mandatory mobility agreement in...

42 CFR 413.125 - Payment for home health agency services.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 2 2010-10-01 2010-10-01 false Payment for home health agency services. 413.125 Section 413.125 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM PRINCIPLES OF REASONABLE COST REIMBURSEMENT; PAYMENT FOR END-STAGE RENAL DISEASE...

48 CFR 552.232-72 - Final Payment Under Building Services Contracts.

Code of Federal Regulations, 2010 CFR

2010-10-01

... Building Services Contracts. 552.232-72 Section 552.232-72 Federal Acquisition Regulations System GENERAL... and Clauses 552.232-72 Final Payment Under Building Services Contracts. As prescribed in 532.904(c), insert the following clause: Final Payment Under Building Services Contracts (NOV 2009) Before final...

42 CFR 447.251 - Definitions.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 4 2011-10-01 2011-10-01 false Definitions. 447.251 Section 447.251 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS PAYMENTS FOR SERVICES Payment for Inpatient Hospital and Long-Term Care Facility Services Payment Rates § 447.251 Definitions....

42 CFR 447.251 - Definitions.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 4 2014-10-01 2014-10-01 false Definitions. 447.251 Section 447.251 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS PAYMENTS FOR SERVICES Payment for Inpatient Hospital and Long-Term Care Facility Services Payment Rates § 447.251 Definitions....

42 CFR 447.251 - Definitions.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 42 Public Health 4 2013-10-01 2013-10-01 false Definitions. 447.251 Section 447.251 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS PAYMENTS FOR SERVICES Payment for Inpatient Hospital and Long-Term Care Facility Services Payment Rates § 447.251 Definitions....

42 CFR 447.251 - Definitions.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 4 2012-10-01 2012-10-01 false Definitions. 447.251 Section 447.251 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS PAYMENTS FOR SERVICES Payment for Inpatient Hospital and Long-Term Care Facility Services Payment Rates § 447.251 Definitions....

42 CFR 447.251 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 4 2010-10-01 2010-10-01 false Definitions. 447.251 Section 447.251 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS PAYMENTS FOR SERVICES Payment for Inpatient Hospital and Long-Term Care Facility Services Payment Rates § 447.251 Definitions....

42 CFR 59.207 - Payments.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 1 2010-10-01 2010-10-01 false Payments. 59.207 Section 59.207 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES GRANTS GRANTS FOR FAMILY PLANNING SERVICES Grants for Family Planning Service Training § 59.207 Payments. The Secretary shall from time to time make...

42 CFR 59.207 - Payments.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 1 2012-10-01 2012-10-01 false Payments. 59.207 Section 59.207 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES GRANTS GRANTS FOR FAMILY PLANNING SERVICES Grants for Family Planning Service Training § 59.207 Payments. The Secretary shall from time to time make...

42 CFR 59.207 - Payments.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 1 2014-10-01 2014-10-01 false Payments. 59.207 Section 59.207 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES GRANTS GRANTS FOR FAMILY PLANNING SERVICES Grants for Family Planning Service Training § 59.207 Payments. The Secretary shall from time to time make...

42 CFR 59.207 - Payments.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 42 Public Health 1 2013-10-01 2013-10-01 false Payments. 59.207 Section 59.207 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES GRANTS GRANTS FOR FAMILY PLANNING SERVICES Grants for Family Planning Service Training § 59.207 Payments. The Secretary shall from time to time make...

42 CFR 59.207 - Payments.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 1 2011-10-01 2011-10-01 false Payments. 59.207 Section 59.207 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES GRANTS GRANTS FOR FAMILY PLANNING SERVICES Grants for Family Planning Service Training § 59.207 Payments. The Secretary shall from time to time make...

42 CFR 414.46 - Additional rules for payment of anesthesia services.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 3 2012-10-01 2012-10-01 false Additional rules for payment of anesthesia services... SERVICES Physicians and Other Practitioners § 414.46 Additional rules for payment of anesthesia services... the value for each anesthesia code that reflects all activities other than anesthesia time. These...

42 CFR § 512.703 - CR incentive payment model participants.

Code of Federal Regulations, 2010 CFR

2017-10-01

... 42 Public Health 5 2017-10-01 2017-10-01 false CR incentive payment model participants. § 512.703... SERVICES (CONTINUED) HEALTH CARE INFRASTRUCTURE AND MODEL PROGRAMS EPISODE PAYMENT MODEL CR Incentive Payment Model for EPM and Medicare Fee-for-Service Participants § 512.703 CR incentive payment model...

Design and Promotion Strategy of Marketing Platform of Aquatic Auction based on Internet

NASA Astrophysics Data System (ADS)

Peng, Jianliang

For the online trade and promotion of aquatic products and related materials through the network between supply and demand, the design content and effective promotional strategies of aquatic auctions online marketing platform is proposed in this paper. Design elements involve the location of customer service, the basic function of the platform including the purchase of general orders, online auctions, information dissemination, and recommendation of fine products, human services, and payment preferences. Based on network and mobile e-commerce transaction support, the auction platform makes the transaction of aquatic products well in advance. The results are important practical value for the design and application of online marketing platform of aquatic auction.

Specialty Payment Model Opportunities and Assessment

PubMed Central

Mulcahy, Andrew W.; Chan, Chris; Hirshman, Samuel; Huckfeldt, Peter J.; Kofner, Aaron; Liu, Jodi L.; Lovejoy, Susan L.; Popescu, Ioana; Timbie, Justin W.; Hussey, Peter S.

2015-01-01

Abstract Gastroenterology and cardiology services are common and costly among Medicare beneficiaries. Episode-based payment, which aims to create incentives for high-quality, low-cost care, has been identified as a promising alternative payment model. This article describes research related to the design of episode-based payment models for ambulatory gastroenterology and cardiology services for possible testing by the Center for Medicare and Medicaid Innovation at the Centers for Medicare and Medicaid Services (CMS). The authors analyzed Medicare claims data to describe the frequency and characteristics of gastroenterology and cardiology index procedures, the practices that delivered index procedures, and the patients that received index procedures. The results of these analyses can help inform CMS decisions about the definition of episodes in an episode-based payment model; payment adjustments for service setting, multiple procedures, or other factors; and eligibility for the payment model. PMID:28083363

High Levels Of Capitation Payments Needed To Shift Primary Care Toward Proactive Team And Nonvisit Care.

PubMed

Basu, Sanjay; Phillips, Russell S; Song, Zirui; Bitton, Asaf; Landon, Bruce E

2017-09-01

Capitated payments in the form of fixed monthly payments to cover all of the costs associated with delivering primary care could encourage primary care practices to transform the way they deliver care. Using a microsimulation model incorporating data from 969 US practices, we sought to understand whether shifting to team- and non-visit-based care is financially sustainable for practices under traditional fee-for-service, capitated payment, or a mix of the two. Practice revenues and costs were computed for fee-for-service payments and a range of capitated payments, before and after the substitution of team- and non-visit-based services for low-complexity in-person physician visits. The substitution produced financial losses for simulated practices under fee-for-service payment of $42,398 per full-time-equivalent physician per year; however, substitution produced financial gains under capitated payment in 95 percent of cases, if more than 63 percent of annual payments were capitated. Shifting to capitated payment might create an incentive for practices to increase their delivery of team- and non-visit-based primary care, if capitated payment levels were sufficiently high. Project HOPE—The People-to-People Health Foundation, Inc.

47 CFR 54.645 - Payment process.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 47 Telecommunication 3 2013-10-01 2013-10-01 false Payment process. 54.645 Section 54.645 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) COMMON CARRIER SERVICES (CONTINUED) UNIVERSAL SERVICE Universal Service Support for Health Care Providers Healthcare Connect Fund § 54.645 Payment...

47 CFR 54.645 - Payment process.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 47 Telecommunication 3 2014-10-01 2014-10-01 false Payment process. 54.645 Section 54.645 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) COMMON CARRIER SERVICES (CONTINUED) UNIVERSAL SERVICE Universal Service Support for Health Care Providers Healthcare Connect Fund § 54.645 Payment...

42 CFR 415.102 - Conditions for fee schedule payment for physician services to beneficiaries in providers.

Code of Federal Regulations, 2010 CFR

2010-10-01

... case of radiology or laboratory services, the additional requirements in § 415.120 or § 415.130... conditions for payment for radiology services) and 415.130 (concerning conditions for payment for physician...

42 CFR 413.13 - Amount of payment if customary charges for services furnished are less than reasonable costs.

Code of Federal Regulations, 2010 CFR

2010-10-01

... efficient delivery of the service, and subject to the exclusions specified in paragraph (d) of this section... facility services. Skilled nursing facility services subject to the payment methodology set forth in §§ 413... 42 Public Health 2 2010-10-01 2010-10-01 false Amount of payment if customary charges for services...

7 CFR 4288.113 - Payment record requirements.

Code of Federal Regulations, 2014 CFR

2014-01-01

... SERVICE AND RURAL UTILITIES SERVICE, DEPARTMENT OF AGRICULTURE PAYMENT PROGRAMS Advanced Biofuel Payment... for Program payments, an advanced biofuel producer must maintain records for all relevant fiscal years and fiscal year quarters for each advanced biofuel facility indicating: (a) The type of eligible...

42 CFR 447.321 - Outpatient hospital and clinic services: Application of upper payment limits.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 4 2010-10-01 2010-10-01 false Outpatient hospital and clinic services: Application of upper payment limits. 447.321 Section 447.321 Public Health CENTERS FOR MEDICARE & MEDICAID... Clinic Services § 447.321 Outpatient hospital and clinic services: Application of upper payment limits...

42 CFR 414.56 - Payment for nurse practitioners' and clinical nurse specialists' services.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 3 2010-10-01 2010-10-01 false Payment for nurse practitioners' and clinical nurse... HEALTH SERVICES Physicians and Other Practitioners § 414.56 Payment for nurse practitioners' and clinical nurse specialists' services. (a) Rural areas. For services furnished beginning January 1, 1992 and...

42 CFR 414.58 - Payment of charges for physician services to patients in providers.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 3 2010-10-01 2010-10-01 false Payment of charges for physician services to patients in providers. 414.58 Section 414.58 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM PAYMENT FOR PART B MEDICAL AND OTHER...

42 CFR 408.65 - Payment options.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 2 2010-10-01 2010-10-01 false Payment options. 408.65 Section 408.65 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM PREMIUMS FOR SUPPLEMENTARY MEDICAL INSURANCE Direct Remittance: Individual Payment § 408.65 Payment options...

42 CFR 412.332 - Payment based on the hospital-specific rate.

Code of Federal Regulations, 2010 CFR

2010-10-01

... HUMAN SERVICES MEDICARE PROGRAM PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Prospective Payment System for Inpatient Hospital Capital Costs Determination of Transition Period Payment Rates for... (f) is determined by multiplying the applicable hospital-specific rate by the DRG weighting factor...

42 CFR 413.239 - Transition period.

Code of Federal Regulations, 2010 CFR

2010-10-01

... PRINCIPLES OF REASONABLE COST REIMBURSEMENT; PAYMENT FOR END-STAGE RENAL DISEASE SERVICES; OPTIONAL PROSPECTIVELY DETERMINED PAYMENT RATES FOR SKILLED NURSING FACILITIES Payment for End-Stage Renal Disease (ESRD...-treatment payment amount for renal dialysis services (as defined in § 413.171 of this part) and home...

Specialty Payment Model Opportunities and Assessment: Gastroenterology and Cardiology Model Design Report.

PubMed

Mulcahy, Andrew W; Chan, Chris; Hirshman, Samuel; Huckfeldt, Peter J; Kofner, Aaron; Liu, Jodi L; Lovejoy, Susan L; Popescu, Ioana; Timbie, Justin W; Hussey, Peter S

2015-07-15

Gastroenterology and cardiology services are common and costly among Medicare beneficiaries. Episode-based payment, which aims to create incentives for high-quality, low-cost care, has been identified as a promising alternative payment model. This article describes research related to the design of episode-based payment models for ambulatory gastroenterology and cardiology services for possible testing by the Center for Medicare and Medicaid Innovation at the Centers for Medicare and Medicaid Services (CMS). The authors analyzed Medicare claims data to describe the frequency and characteristics of gastroenterology and cardiology index procedures, the practices that delivered index procedures, and the patients that received index procedures. The results of these analyses can help inform CMS decisions about the definition of episodes in an episode-based payment model; payment adjustments for service setting, multiple procedures, or other factors; and eligibility for the payment model.

42 CFR 413.316 - Determining payment amounts: Ancillary services.

Code of Federal Regulations, 2010 CFR

2010-10-01

... RENAL DISEASE SERVICES; OPTIONAL PROSPECTIVELY DETERMINED PAYMENT RATES FOR SKILLED NURSING FACILITIES Prospectively Determined Payment Rates for Low-Volume Skilled Nursing Facilities, for Cost Reporting Periods...

42 CFR 413.316 - Determining payment amounts: Ancillary services.

Code of Federal Regulations, 2013 CFR

2013-10-01

... RENAL DISEASE SERVICES; OPTIONAL PROSPECTIVELY DETERMINED PAYMENT RATES FOR SKILLED NURSING FACILITIES Prospectively Determined Payment Rates for Low-Volume Skilled Nursing Facilities, for Cost Reporting Periods...

Value-Based Payment Reform and the Medicare Access and Children's Health Insurance Program Reauthorization Act of 2015: A Primer for Plastic Surgeons.

PubMed

Squitieri, Lee; Chung, Kevin C

2017-07-01

In 2015, the U.S. Congress passed the Medicare Access and Children's Health Insurance Program Reauthorization Act, which effectively repealed the Centers for Medicare and Medicaid Services sustainable growth rate formula and established the Centers for Medicare and Medicaid Services Quality Payment Program. The Medicare Access and Children's Health Insurance Program Reauthorization Act represents an unparalleled acceleration toward value-based payment models and a departure from traditional volume-driven fee-for-service reimbursement. The Quality Payment Program includes two paths for provider participation: the Merit-Based Incentive Payment System and Advanced Alternative Payment Models. The Merit-Based Incentive Payment System pathway replaces existing quality reporting programs and adds several new measures to create a composite performance score for each provider (or provider group) that will be used to adjust reimbursed payment. The advanced alternative payment model pathway is available to providers who participate in qualifying Advanced Alternative Payment Models and is associated with an initial 5 percent payment incentive. The first performance period for the Merit-Based Incentive Payment System opens January 1, 2017, and closes on December 31, 2017, and is associated with payment adjustments in January of 2019. The Centers for Medicare and Medicaid Services estimates that the majority of providers will begin participation in 2017 through the Merit-Based Incentive Payment System pathway, but aims to have 50 percent of payments tied to quality or value through Advanced Alternative Payment Models by 2018. In this article, the authors describe key components of the Medicare Access and Children's Health Insurance Program Reauthorization Act to providers navigating through the Quality Payment Program and discuss how plastic surgeons may optimize their performance in this new value-based payment program.

42 CFR 415.164 - Payment to a fund.

Code of Federal Regulations, 2010 CFR

2010-10-01

...) MEDICARE PROGRAM SERVICES FURNISHED BY PHYSICIANS IN PROVIDERS, SUPERVISING PHYSICIANS IN TEACHING SETTINGS, AND RESIDENTS IN CERTAIN SETTINGS Physician Services in Teaching Settings § 415.164 Payment to a fund. (a) General rules. Payment for certain voluntary services by physicians in teaching hospitals (as...

42 CFR § 512.705 - CR/ICR services that count towards CR incentive payments.

Code of Federal Regulations, 2010 CFR

2017-10-01

... PAYMENT MODEL CR Incentive Payment Model for EPM and Medicare Fee-for-Service Participants § 512.705 CR... beneficiaries during AMI and CABG model episodes result in eligibility for CR incentive payments. (2) For FFS-CR... an AMI or CABG model episode. (d) CR incentive payment time period. All AMI and CABG model episodes...

A Truthful Incentive Mechanism for Online Recruitment in Mobile Crowd Sensing System.

PubMed

Chen, Xiao; Liu, Min; Zhou, Yaqin; Li, Zhongcheng; Chen, Shuang; He, Xiangnan

2017-01-01

We investigate emerging mobile crowd sensing (MCS) systems, in which new cloud-based platforms sequentially allocate homogenous sensing jobs to dynamically-arriving users with uncertain service qualities. Given that human beings are selfish in nature, it is crucial yet challenging to design an efficient and truthful incentive mechanism to encourage users to participate. To address the challenge, we propose a novel truthful online auction mechanism that can efficiently learn to make irreversible online decisions on winner selections for new MCS systems without requiring previous knowledge of users. Moreover, we theoretically prove that our incentive possesses truthfulness, individual rationality and computational efficiency. Extensive simulation results under both real and synthetic traces demonstrate that our incentive mechanism can reduce the payment of the platform, increase the utility of the platform and social welfare.

42 CFR 62.28 - Under what circumstances can the service or payment obligation be canceled, waived or suspended?

Code of Federal Regulations, 2010 CFR

2010-10-01

... obligation be canceled, waived or suspended? 62.28 Section 62.28 Public Health PUBLIC HEALTH SERVICE... what circumstances can the service or payment obligation be canceled, waived or suspended? A service or payment obligation under the Loan Repayment Program will be canceled or may be waived or suspended as...

76 FR 50949 - Withholding on Payments by Government Entities to Persons Providing Property or Services; Hearing

Federal Register 2010, 2011, 2012, 2013, 2014

2011-08-17

... DEPARTMENT OF THE TREASURY Internal Revenue Service 26 CFR Part 31 [REG-151687-10] RIN 1545-BJ98 Withholding on Payments by Government Entities to Persons Providing Property or Services; Hearing AGENCY... government entities on payments to persons providing property or services. DATES: The public hearing is being...

45 CFR 1357.40 - Direct payments to Indian Tribal Organizations (title IV-B, subpart 1, child welfare services).

Code of Federal Regulations, 2010 CFR

2010-10-01

... (title IV-B, subpart 1, child welfare services). 1357.40 Section 1357.40 Public Welfare Regulations... SERVICES THE ADMINISTRATION ON CHILDREN, YOUTH AND FAMILIES, FOSTER CARE MAINTENANCE PAYMENTS, ADOPTION ASSISTANCE, AND CHILD AND FAMILY SERVICES REQUIREMENTS APPLICABLE TO TITLE IV-B § 1357.40 Direct payments to...

5 CFR 1315.9 - Required documentation.

Code of Federal Regulations, 2011 CFR

2011-01-01

... following delivery to inspect and/or test goods furnished or to evaluate services performed is stated; (6... later than the first request for payment; (9) If using Fast Payment, the proper FAR clause stipulating Fast Payment is required. (b)(1) Except for interim payment requests under cost-reimbursement service...

42 CFR 460.182 - Medicaid payment.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 4 2010-10-01 2010-10-01 false Medicaid payment. 460.182 Section 460.182 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED...) Payment § 460.182 Medicaid payment. (a) Under a PACE program agreement, the State administering agency...

42 CFR 412.535 - Publication of the Federal prospective payment rates.

Code of Federal Regulations, 2010 CFR

2010-10-01

... HEALTH AND HUMAN SERVICES MEDICARE PROGRAM PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Prospective Payment System for Long-Term Care Hospitals § 412.535 Publication of the Federal prospective... care hospital prospective payment system effective for each annual update in the Federal Register. (a...

42 CFR § 414.1435 - Qualifying APM participant determination: Medicare option.

Code of Federal Regulations, 2010 CFR

2017-10-01

..., DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM (CONTINUED) PAYMENT FOR PART B MEDICAL AND OTHER HEALTH SERVICES Merit-Based Incentive Payment System and Alternative Payment Model Incentive § 414.1435 Qualifying APM participant determination: Medicare option. (a) Payment amount method. The...

42 CFR § 414.1330 - Quality performance category.

Code of Federal Regulations, 2010 CFR

2017-10-01

... SERVICES (CONTINUED) MEDICARE PROGRAM (CONTINUED) PAYMENT FOR PART B MEDICAL AND OTHER HEALTH SERVICES Merit-Based Incentive Payment System and Alternative Payment Model Incentive § 414.1330 Quality... comprise: (1) 60 percent of a MIPS eligible clinician's final score for MIPS payment year 2019. (2) 50...

42 CFR 414.313 - Initial method of payment.

Code of Federal Regulations, 2010 CFR

2010-10-01

... inpatients who were not admitted solely to receive maintenance dialysis. (iv) Administration of hepatitis B... (CONTINUED) MEDICARE PROGRAM PAYMENT FOR PART B MEDICAL AND OTHER HEALTH SERVICES Determination of Reasonable... of this subchapter. (b) Services for which payment is not included in the add-on payment. (1...

42 CFR 416.200 - Payment adjustment.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 3 2010-10-01 2010-10-01 false Payment adjustment. 416.200 Section 416.200 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED... in connection with ASC facility services. (b) CMS adjusts the payment for insertion of an IOL...

42 CFR 416.200 - Payment adjustment.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 3 2011-10-01 2011-10-01 false Payment adjustment. 416.200 Section 416.200 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED... in connection with ASC facility services. (b) CMS adjusts the payment for insertion of an IOL...

42 CFR 414.102 - General payment rules.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 3 2011-10-01 2011-10-01 false General payment rules. 414.102 Section 414.102 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM PAYMENT FOR PART B MEDICAL AND OTHER HEALTH SERVICES Fee Schedules for...

42 CFR 414.102 - General payment rules.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 3 2010-10-01 2010-10-01 false General payment rules. 414.102 Section 414.102 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM PAYMENT FOR PART B MEDICAL AND OTHER HEALTH SERVICES Fee Schedules for...

42 CFR 414.102 - General payment rules.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 42 Public Health 3 2013-10-01 2013-10-01 false General payment rules. 414.102 Section 414.102 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM (CONTINUED) PAYMENT FOR PART B MEDICAL AND OTHER HEALTH SERVICES Fee Schedules...

42 CFR 414.102 - General payment rules.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 3 2012-10-01 2012-10-01 false General payment rules. 414.102 Section 414.102 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM (CONTINUED) PAYMENT FOR PART B MEDICAL AND OTHER HEALTH SERVICES Fee Schedules...

42 CFR 414.102 - General payment rules.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 3 2014-10-01 2014-10-01 false General payment rules. 414.102 Section 414.102 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM (CONTINUED) PAYMENT FOR PART B MEDICAL AND OTHER HEALTH SERVICES Fee Schedules...

42 CFR 410.163 - Payment for services furnished to kidney donors.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 2 2010-10-01 2010-10-01 false Payment for services furnished to kidney donors... Benefits § 410.163 Payment for services furnished to kidney donors. Notwithstanding any other provisions of... an individual who donates a kidney for transplant surgery. ...

42 CFR 410.163 - Payment for services furnished to kidney donors.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 2 2011-10-01 2011-10-01 false Payment for services furnished to kidney donors... Benefits § 410.163 Payment for services furnished to kidney donors. Notwithstanding any other provisions of... an individual who donates a kidney for transplant surgery. ...

42 CFR 66.108 - Payments to institutions.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 1 2012-10-01 2012-10-01 false Payments to institutions. 66.108 Section 66.108 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES FELLOWSHIPS, INTERNSHIPS, TRAINING NATIONAL RESEARCH SERVICE AWARDS Direct Awards § 66.108 Payments to institutions. The institution...

42 CFR 66.108 - Payments to institutions.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 1 2010-10-01 2010-10-01 false Payments to institutions. 66.108 Section 66.108 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES FELLOWSHIPS, INTERNSHIPS, TRAINING NATIONAL RESEARCH SERVICE AWARDS Direct Awards § 66.108 Payments to institutions. The institution...

42 CFR 66.107 - Payments to awardees.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 1 2010-10-01 2010-10-01 false Payments to awardees. 66.107 Section 66.107 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES FELLOWSHIPS, INTERNSHIPS, TRAINING NATIONAL RESEARCH SERVICE AWARDS Direct Awards § 66.107 Payments to awardees. (a) Individuals receiving...

42 CFR 66.107 - Payments to awardees.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 1 2012-10-01 2012-10-01 false Payments to awardees. 66.107 Section 66.107 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES FELLOWSHIPS, INTERNSHIPS, TRAINING NATIONAL RESEARCH SERVICE AWARDS Direct Awards § 66.107 Payments to awardees. (a) Individuals receiving...

42 CFR 66.108 - Payments to institutions.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 42 Public Health 1 2013-10-01 2013-10-01 false Payments to institutions. 66.108 Section 66.108 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES FELLOWSHIPS, INTERNSHIPS, TRAINING NATIONAL RESEARCH SERVICE AWARDS Direct Awards § 66.108 Payments to institutions. The institution...

42 CFR 66.107 - Payments to awardees.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 1 2011-10-01 2011-10-01 false Payments to awardees. 66.107 Section 66.107 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES FELLOWSHIPS, INTERNSHIPS, TRAINING NATIONAL RESEARCH SERVICE AWARDS Direct Awards § 66.107 Payments to awardees. (a) Individuals receiving...

42 CFR 66.108 - Payments to institutions.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 1 2011-10-01 2011-10-01 false Payments to institutions. 66.108 Section 66.108 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES FELLOWSHIPS, INTERNSHIPS, TRAINING NATIONAL RESEARCH SERVICE AWARDS Direct Awards § 66.108 Payments to institutions. The institution...

42 CFR 66.107 - Payments to awardees.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 42 Public Health 1 2013-10-01 2013-10-01 false Payments to awardees. 66.107 Section 66.107 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES FELLOWSHIPS, INTERNSHIPS, TRAINING NATIONAL RESEARCH SERVICE AWARDS Direct Awards § 66.107 Payments to awardees. (a) Individuals receiving...

42 CFR 66.107 - Payments to awardees.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 1 2014-10-01 2014-10-01 false Payments to awardees. 66.107 Section 66.107 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES FELLOWSHIPS, INTERNSHIPS, TRAINING NATIONAL RESEARCH SERVICE AWARDS Direct Awards § 66.107 Payments to awardees. (a) Individuals receiving...

42 CFR 66.108 - Payments to institutions.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 1 2014-10-01 2014-10-01 false Payments to institutions. 66.108 Section 66.108 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES FELLOWSHIPS, INTERNSHIPS, TRAINING NATIONAL RESEARCH SERVICE AWARDS Direct Awards § 66.108 Payments to institutions. The institution...

The national health insurance scheme: perceptions and experiences of health care providers and clients in two districts of Ghana.

PubMed

Dalinjong, Philip Ayizem; Laar, Alexander Suuk

2012-07-23

Prepayments and risk pooling through social health insurance has been advocated by international development organizations. Social health insurance is seen as a mechanism that helps mobilize resources for health, pool risk, and provide more access to health care services for the poor. Hence Ghana implemented the National Health Insurance Scheme (NHIS) to help promote access to health care services for Ghanaians. The study examined the influence of the NHIS on the behavior of health care providers in their treatment of insured and uninsured clients. The study took place in Bolgatanga (urban) and Builsa (rural) districts in Ghana. Data was collected through exit survey with 200 insured and uninsured clients, 15 in-depth interviews with health care providers and health insurance managers, and 8 focus group discussions with insured and uninsured community members. The NHIS promoted access for insured and mobilized revenue for health care providers. Both insured and uninsured were satisfied with care (survey finding). However, increased utilization of health care services by the insured leading to increased workloads for providers influenced their behavior towards the insured. Most of the insured perceived and experienced long waiting times, verbal abuse, not being physically examined and discrimination in favor of the affluent and uninsured. The insured attributed their experience to the fact that they were not making immediate payments for services. A core challenge of the NHIS was a delay in reimbursement which affected the operations of health facilities and hence influenced providers' behavior as well. Providers preferred clients who would make instant payments for health care services. Few of the uninsured were utilizing health facilities and visit only in critical conditions. This is due to the increased cost of health care services under the NHIS. The perceived opportunistic behavior of the insured by providers was responsible for the difference in the behavior of providers favoring the uninsured. Besides, the delay in reimbursement also accounted for providers' negative attitude towards the insured. There is urgent need to address these issues in order to promote confidence in the NHIS, as well as its sustainability for the achievement of universal coverage.

The national health insurance scheme: perceptions and experiences of health care providers and clients in two districts of Ghana

PubMed Central

2012-01-01

Background Prepayments and risk pooling through social health insurance has been advocated by international development organizations. Social health insurance is seen as a mechanism that helps mobilize resources for health, pool risk, and provide more access to health care services for the poor. Hence Ghana implemented the National Health Insurance Scheme (NHIS) to help promote access to health care services for Ghanaians. The study examined the influence of the NHIS on the behavior of health care providers in their treatment of insured and uninsured clients. Methods The study took place in Bolgatanga (urban) and Builsa (rural) districts in Ghana. Data was collected through exit survey with 200 insured and uninsured clients, 15 in-depth interviews with health care providers and health insurance managers, and 8 focus group discussions with insured and uninsured community members. Results The NHIS promoted access for insured and mobilized revenue for health care providers. Both insured and uninsured were satisfied with care (survey finding). However, increased utilization of health care services by the insured leading to increased workloads for providers influenced their behavior towards the insured. Most of the insured perceived and experienced long waiting times, verbal abuse, not being physically examined and discrimination in favor of the affluent and uninsured. The insured attributed their experience to the fact that they were not making immediate payments for services. A core challenge of the NHIS was a delay in reimbursement which affected the operations of health facilities and hence influenced providers’ behavior as well. Providers preferred clients who would make instant payments for health care services. Few of the uninsured were utilizing health facilities and visit only in critical conditions. This is due to the increased cost of health care services under the NHIS. Conclusion The perceived opportunistic behavior of the insured by providers was responsible for the difference in the behavior of providers favoring the uninsured. Besides, the delay in reimbursement also accounted for providers’ negative attitude towards the insured. There is urgent need to address these issues in order to promote confidence in the NHIS, as well as its sustainability for the achievement of universal coverage. PMID:22828034

42 CFR 412.89 - Payment adjustment for certain replaced devices.

Code of Federal Regulations, 2010 CFR

2010-10-01

... HUMAN SERVICES MEDICARE PROGRAM PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Payments for... implantation of the device determines the DRG assignment. (2) CMS lists the DRGs that qualify under paragraph (b)(1) of this section in the annual final rule for the hospital inpatient prospective payment system...

42 CFR 419.40 - Payment concepts.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 3 2010-10-01 2010-10-01 false Payment concepts. 419.40 Section 419.40 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED... Hospitals § 419.40 Payment concepts. (a) In addition to the payment rate described in § 419.32, for each APC...

42 CFR 484.245 - Accelerated payments for home health agencies.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 5 2011-10-01 2011-10-01 false Accelerated payments for home health agencies. 484... HUMAN SERVICES (CONTINUED) STANDARDS AND CERTIFICATION HOME HEALTH SERVICES Prospective Payment System for Home Health Agencies § 484.245 Accelerated payments for home health agencies. (a) General rule...

42 CFR 484.245 - Accelerated payments for home health agencies.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 5 2012-10-01 2012-10-01 false Accelerated payments for home health agencies. 484... HUMAN SERVICES (CONTINUED) STANDARDS AND CERTIFICATION HOME HEALTH SERVICES Prospective Payment System for Home Health Agencies § 484.245 Accelerated payments for home health agencies. (a) General rule...

42 CFR 484.245 - Accelerated payments for home health agencies.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 5 2010-10-01 2010-10-01 false Accelerated payments for home health agencies. 484... HUMAN SERVICES (CONTINUED) STANDARDS AND CERTIFICATION HOME HEALTH SERVICES Prospective Payment System for Home Health Agencies § 484.245 Accelerated payments for home health agencies. (a) General rule...

42 CFR 419.20 - Hospitals subject to the hospital outpatient prospective payment system.

Code of Federal Regulations, 2010 CFR

2010-10-01

... prospective payment system. 419.20 Section 419.20 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM PROSPECTIVE PAYMENT SYSTEM FOR HOSPITAL... Outpatient Prospective Payment System § 419.20 Hospitals subject to the hospital outpatient prospective...

42 CFR 412.304 - Implementation of the capital prospective payment system.

Code of Federal Regulations, 2010 CFR

2010-10-01

... HEALTH AND HUMAN SERVICES MEDICARE PROGRAM PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Prospective Payment System for Inpatient Hospital Capital Costs General Provisions § 412.304 Implementation of the capital prospective payment system. (a) General rule. As described in §§ 412.312 through 412.370...

42 CFR § 414.1410 - Advanced APM determination.

Code of Federal Regulations, 2010 CFR

2017-10-01

... SERVICES (CONTINUED) MEDICARE PROGRAM (CONTINUED) PAYMENT FOR PART B MEDICAL AND OTHER HEALTH SERVICES Merit-Based Incentive Payment System and Alternative Payment Model Incentive § 414.1410 Advanced APM determination. (a) General. An APM is an Advanced APM for a payment year if CMS determines that it meets the...

42 CFR § 414.1370 - APM scoring standard under MIPS.

Code of Federal Regulations, 2010 CFR

2017-10-01

... SERVICES (CONTINUED) MEDICARE PROGRAM (CONTINUED) PAYMENT FOR PART B MEDICAL AND OTHER HEALTH SERVICES Merit-Based Incentive Payment System and Alternative Payment Model Incentive § 414.1370 APM scoring... Participation List; (3) The APM bases payment on cost/utilization and quality measures; and (4) The APM is not...

42 CFR § 414.1425 - Qualifying APM participant determination: In general.

Code of Federal Regulations, 2010 CFR

2017-10-01

..., DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM (CONTINUED) PAYMENT FOR PART B MEDICAL AND OTHER HEALTH SERVICES Merit-Based Incentive Payment System and Alternative Payment Model Incentive... Score that meets or exceeds the corresponding QP payment amount threshold or QP patient count threshold...

42 CFR § 414.1350 - Cost performance category.

Code of Federal Regulations, 2010 CFR

2017-10-01

... SERVICES (CONTINUED) MEDICARE PROGRAM (CONTINUED) PAYMENT FOR PART B MEDICAL AND OTHER HEALTH SERVICES Merit-Based Incentive Payment System and Alternative Payment Model Incentive § 414.1350 Cost performance... category comprises: (1) 0 percent of a MIPS eligible clinician's final score for MIPS payment year 2019. (2...

42 CFR § 414.1440 - Qualifying APM participant determination: All-payer combination option.

Code of Federal Regulations, 2010 CFR

2017-10-01

..., DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM (CONTINUED) PAYMENT FOR PART B MEDICAL AND OTHER HEALTH SERVICES Merit-Based Incentive Payment System and Alternative Payment Model Incentive § 414.1440 Qualifying APM participant determination: All-payer combination option. (a) Payments excluded...

42 CFR § 414.1385 - Targeted review and review limitations.

Code of Federal Regulations, 2010 CFR

2017-10-01

... SERVICES (CONTINUED) MEDICARE PROGRAM (CONTINUED) PAYMENT FOR PART B MEDICAL AND OTHER HEALTH SERVICES Merit-Based Incentive Payment System and Alternative Payment Model Incentive § 414.1385 Targeted review... review of the calculation of the MIPS payment adjustment factor under section 1848(q)(6)(A) of the Act...

42 CFR § 414.1355 - Improvement activities performance category.

Code of Federal Regulations, 2010 CFR

2017-10-01

... AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM (CONTINUED) PAYMENT FOR PART B MEDICAL AND OTHER HEALTH SERVICES Merit-Based Incentive Payment System and Alternative Payment Model Incentive § 414.1355... comprises: (1) 15 percent of a MIPS eligible clinician's final score for MIPS payment year 2019 and for each...

42 CFR § 414.1340 - Data completeness criteria for the quality performance category.

Code of Federal Regulations, 2010 CFR

2017-10-01

..., DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM (CONTINUED) PAYMENT FOR PART B MEDICAL AND OTHER HEALTH SERVICES Merit-Based Incentive Payment System and Alternative Payment Model Incentive... that meet the measure's denominator criteria, regardless of payer for MIPS payment year 2019. (2) At...

42 CFR 130.3 - Amount of payments.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 1 2010-10-01 2010-10-01 false Amount of payments. 130.3 Section 130.3 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES COMPASSIONATE PAYMENTS RICKY RAY HEMOPHILIA RELIEF FUND PROGRAM General Provisions § 130.3 Amount of payments. If there are sufficient amounts...

42 CFR 102.83 - Payment of all benefits.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 42 Public Health 1 2013-10-01 2013-10-01 false Payment of all benefits. 102.83 Section 102.83 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES VACCINES SMALLPOX COMPENSATION PROGRAM Calculation and Payment of Benefits § 102.83 Payment of all benefits. (a) The Secretary...

42 CFR 102.83 - Payment of all benefits.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 1 2011-10-01 2011-10-01 false Payment of all benefits. 102.83 Section 102.83 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES VACCINES SMALLPOX COMPENSATION PROGRAM Calculation and Payment of Benefits § 102.83 Payment of all benefits. (a) The Secretary...

42 CFR 102.83 - Payment of all benefits.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 1 2014-10-01 2014-10-01 false Payment of all benefits. 102.83 Section 102.83 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES VACCINES SMALLPOX COMPENSATION PROGRAM Calculation and Payment of Benefits § 102.83 Payment of all benefits. (a) The Secretary...

42 CFR 102.83 - Payment of all benefits.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 1 2012-10-01 2012-10-01 false Payment of all benefits. 102.83 Section 102.83 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES VACCINES SMALLPOX COMPENSATION PROGRAM Calculation and Payment of Benefits § 102.83 Payment of all benefits. (a) The Secretary...

7 CFR 3550.152 - Loan payments.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 7 Agriculture 15 2011-01-01 2011-01-01 false Loan payments. 3550.152 Section 3550.152 Agriculture Regulations of the Department of Agriculture (Continued) RURAL HOUSING SERVICE, DEPARTMENT OF AGRICULTURE DIRECT SINGLE FAMILY HOUSING LOANS AND GRANTS Regular Servicing § 3550.152 Loan payments. (a) Payment terms. Unless the loan documents specify...

7 CFR 3550.152 - Loan payments.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 7 Agriculture 15 2014-01-01 2014-01-01 false Loan payments. 3550.152 Section 3550.152 Agriculture Regulations of the Department of Agriculture (Continued) RURAL HOUSING SERVICE, DEPARTMENT OF AGRICULTURE DIRECT SINGLE FAMILY HOUSING LOANS AND GRANTS Regular Servicing § 3550.152 Loan payments. (a) Payment terms. Unless the loan documents specify...

7 CFR 3550.152 - Loan payments.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 15 2010-01-01 2010-01-01 false Loan payments. 3550.152 Section 3550.152 Agriculture Regulations of the Department of Agriculture (Continued) RURAL HOUSING SERVICE, DEPARTMENT OF AGRICULTURE DIRECT SINGLE FAMILY HOUSING LOANS AND GRANTS Regular Servicing § 3550.152 Loan payments. (a) Payment terms. Unless the loan documents specify...

7 CFR 3550.152 - Loan payments.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 7 Agriculture 15 2013-01-01 2013-01-01 false Loan payments. 3550.152 Section 3550.152 Agriculture Regulations of the Department of Agriculture (Continued) RURAL HOUSING SERVICE, DEPARTMENT OF AGRICULTURE DIRECT SINGLE FAMILY HOUSING LOANS AND GRANTS Regular Servicing § 3550.152 Loan payments. (a) Payment terms. Unless the loan documents specify...

7 CFR 3550.152 - Loan payments.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 7 Agriculture 15 2012-01-01 2012-01-01 false Loan payments. 3550.152 Section 3550.152 Agriculture Regulations of the Department of Agriculture (Continued) RURAL HOUSING SERVICE, DEPARTMENT OF AGRICULTURE DIRECT SINGLE FAMILY HOUSING LOANS AND GRANTS Regular Servicing § 3550.152 Loan payments. (a) Payment terms. Unless the loan documents specify...

42 CFR § 414.1325 - Data submission requirements.

Code of Federal Regulations, 2010 CFR

2017-10-01

... SERVICES (CONTINUED) MEDICARE PROGRAM (CONTINUED) PAYMENT FOR PART B MEDICAL AND OTHER HEALTH SERVICES Merit-Based Incentive Payment System and Alternative Payment Model Incentive § 414.1325 Data submission...

42 CFR 416.125 - ASC facility services payment rate.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 3 2011-10-01 2011-10-01 false ASC facility services payment rate. 416.125 Section 416.125 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN... connection with the performance of that procedure. (b) The payment must be substantially less than would have...

42 CFR 416.125 - ASC facility services payment rate.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 3 2010-10-01 2010-10-01 false ASC facility services payment rate. 416.125 Section 416.125 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN... connection with the performance of that procedure. (b) The payment must be substantially less than would have...

42 CFR 416.171 - Determination of payment rates for ASC services.

Code of Federal Regulations, 2013 CFR

2013-10-01

... services. (d) Limitation on payment rates for office-based surgical procedures and covered ancillary... nonfacility practice expense relative value units under § 414.22(b)(5)(i)(B) of this subchapter multiplied by... payment rate for covered ancillary radiology services that involve certain nuclear medicine procedures...

42 CFR 416.171 - Determination of payment rates for ASC services.

Code of Federal Regulations, 2014 CFR

2014-10-01

... services. (d) Limitation on payment rates for office-based surgical procedures and covered ancillary... nonfacility practice expense relative value units under § 414.22(b)(5)(i)(B) of this subchapter multiplied by... payment rate for covered ancillary radiology services that involve certain nuclear medicine procedures...

42 CFR 418.304 - Payment for physician and nurse practitioner services.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 3 2011-10-01 2011-10-01 false Payment for physician and nurse practitioner... Payment for physician and nurse practitioner services. (a) The following services performed by hospice physicians and nurse practitioners are included in the rates described in § 418.302: (1) General supervisory...

42 CFR § 414.1360 - Data submission criteria for the improvement activities performance category.

Code of Federal Regulations, 2010 CFR

2017-10-01

... & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM (CONTINUED) PAYMENT FOR PART B MEDICAL AND OTHER HEALTH SERVICES Merit-Based Incentive Payment System and Alternative Payment Model Incentive § 414.1360 Data submission criteria for the improvement activities performance...

42 CFR § 414.1430 - Qualifying APM participant determination: QP and partial QP thresholds.

Code of Federal Regulations, 2010 CFR

2017-10-01

... SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM (CONTINUED) PAYMENT FOR PART B MEDICAL AND OTHER HEALTH SERVICES Merit-Based Incentive Payment System and Alternative Payment Model Incentive § 414.1430 Qualifying APM participant determination: QP and partial QP thresholds. (a...

42 CFR 414.46 - Additional rules for payment of anesthesia services.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 3 2011-10-01 2011-10-01 false Additional rules for payment of anesthesia services... Physicians and Other Practitioners § 414.46 Additional rules for payment of anesthesia services. (a... each anesthesia code that reflects all activities other than anesthesia time. These activities include...

42 CFR 414.46 - Additional rules for payment of anesthesia services.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 3 2010-10-01 2010-10-01 false Additional rules for payment of anesthesia services... Physicians and Other Practitioners § 414.46 Additional rules for payment of anesthesia services. (a... each anesthesia code that reflects all activities other than anesthesia time. These activities include...

42 CFR 412.405 - Preadmission services as inpatient operating costs under the inpatient psychiatric facility...

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 2 2011-10-01 2011-10-01 false Preadmission services as inpatient operating costs under the inpatient psychiatric facility prospective payment system. 412.405 Section 412.405 Public... PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Prospective Payment System for Inpatient Hospital...

42 CFR 412.405 - Preadmission services as inpatient operating costs under the inpatient psychiatric facility...

Code of Federal Regulations, 2013 CFR

2013-10-01

... 42 Public Health 2 2013-10-01 2013-10-01 false Preadmission services as inpatient operating costs under the inpatient psychiatric facility prospective payment system. 412.405 Section 412.405 Public... PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Prospective Payment System for Inpatient Hospital...

42 CFR 412.405 - Preadmission services as inpatient operating costs under the inpatient psychiatric facility...

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 2 2010-10-01 2010-10-01 false Preadmission services as inpatient operating costs under the inpatient psychiatric facility prospective payment system. 412.405 Section 412.405 Public... PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Prospective Payment System for Inpatient Hospital...

42 CFR 412.405 - Preadmission services as inpatient operating costs under the inpatient psychiatric facility...

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 2 2014-10-01 2014-10-01 false Preadmission services as inpatient operating costs under the inpatient psychiatric facility prospective payment system. 412.405 Section 412.405 Public... PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Prospective Payment System for Inpatient Hospital...

42 CFR 412.405 - Preadmission services as inpatient operating costs under the inpatient psychiatric facility...

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 2 2012-10-01 2012-10-01 false Preadmission services as inpatient operating costs under the inpatient psychiatric facility prospective payment system. 412.405 Section 412.405 Public... PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Prospective Payment System for Inpatient Hospital...

38 CFR 17.1002 - Substantive conditions for payment or reimbursement.

Code of Federal Regulations, 2011 CFR

2011-07-01

... DEPARTMENT OF VETERANS AFFAIRS MEDICAL Payment Or Reimbursement for Emergency Services for Nonservice.... Payment or reimbursement under 38 U.S.C. 1725 for emergency services may be made only if all of the following conditions are met: (a) The emergency services were provided in a hospital emergency department or...

20 CFR 416.976 - Impairment-related work expenses.

Code of Federal Regulations, 2010 CFR

2010-04-01

... work, we will deduct payments you make toward its cost. (5) Payments for drugs and medical services. (i) If you must use drugs or medical services (including diagnostic procedures) to control your impairment(s), the payments you make for them may be deducted. The drugs or services must be prescribed (or...

42 CFR § 414.1390 - Data validation and auditing.

Code of Federal Regulations, 2010 CFR

2017-10-01

... SERVICES (CONTINUED) MEDICARE PROGRAM (CONTINUED) PAYMENT FOR PART B MEDICAL AND OTHER HEALTH SERVICES Merit-Based Incentive Payment System and Alternative Payment Model Incentive § 414.1390 Data validation...

42 CFR 422.216 - Special rules for MA private fee-for-service plans.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 3 2010-10-01 2010-10-01 false Special rules for MA private fee-for-service plans... Providers § 422.216 Special rules for MA private fee-for-service plans. (a) Payment to providers—(1) Payment rate. (i) The MA organization must establish payment rates for plan covered items and services that...

42 CFR 422.216 - Special rules for MA private fee-for-service plans.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 3 2011-10-01 2011-10-01 false Special rules for MA private fee-for-service plans... Providers § 422.216 Special rules for MA private fee-for-service plans. (a) Payment to providers—(1) Payment rate. (i) The MA organization must establish payment rates for plan covered items and services that...

42 CFR 419.22 - Hospital services excluded from payment under the hospital outpatient prospective payment system.

Code of Federal Regulations, 2014 CFR

2014-10-01

... chapter for payment on a fee schedule basis. (b) Nurse practitioner and clinical nurse specialist services, as defined in section 1861(s)(2)(K)(ii) of the Act. (c) Physician assistant services, as defined in section 1861(s)(2)(K)(i) of the Act. (d) Certified nurse-midwife services, as defined in section 1861(gg...

42 CFR § 414.1400 - Third party data submission.

Code of Federal Regulations, 2010 CFR

2017-10-01

... SERVICES (CONTINUED) MEDICARE PROGRAM (CONTINUED) PAYMENT FOR PART B MEDICAL AND OTHER HEALTH SERVICES Merit-Based Incentive Payment System and Alternative Payment Model Incentive § 414.1400 Third party data...

42 CFR § 414.1365 - Subcategories for the improvement activities performance category.

Code of Federal Regulations, 2010 CFR

2017-10-01

..., DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM (CONTINUED) PAYMENT FOR PART B MEDICAL AND OTHER HEALTH SERVICES Merit-Based Incentive Payment System and Alternative Payment Model Incentive...

Effects of transit bus interior configuration on performance of wheeled mobility users during simulated boarding and disembarking.

PubMed

D'Souza, Clive; Paquet, Victor; Lenker, James A; Steinfeld, Edward

2017-07-01

The emergence of low-floor bus designs and related regulatory standards in the U.S. have resulted in substantial improvements in public transit accessibility. However, passengers using wheeled mobility devices still experience safety concerns and inefficiencies in boarding, disembarking, and interior circulation on low-floor buses. This study investigates effects of low-floor bus interior configuration and passenger crowding on boarding and disembarking efficiency and safety. Users of manual wheelchairs (n = 18), powered wheelchairs (n = 21) and electric scooters (n = 9) simulated boarding and disembarking in three interior layout configurations at low and high passenger crowding conditions on a full-scale laboratory mock-up of a low-floor bus. Dependent measures comprised task times and critical incidents during access ramp use, fare payment, and movement to and from the doorway and wheeled mobility securement area. Individual times for unassisted boarding ranged from 15.2 to 245.3 s and for disembarking ranged from 9.1 to 164.6 s across layout and passenger crowding conditions. Nonparametric analysis of variance showed significant differences and interactions across vehicle design conditions, passenger load and mobility device type on user performance. The configuration having electronic on-board fare payment, rear-bus entrance doorways and adjacent device securement areas demonstrated greatest efficiency and safety. High passenger load adversely impacted efficiency and frequency of critical incidents during on-board circulation across all three layouts. Findings have broader implications for improving transit system efficiency and quality of service across the spectrum of transit users. Copyright © 2017 Elsevier Ltd. All rights reserved.

Bundled payment and enhanced recovery after surgery.

PubMed

Huang, Jeffrey

2015-01-01

Medicare's fee-for-service (FFS) payment model may contribute to unsustainable spending growth. Payers are turning to alternative payment methods. The leading alternative payment model to the FFS problem is bundled payment. The Centers for Medicare & Medicaid Services (CMS) is taking another step to improve healthcare quality at lower cost. The CMS's Center for Medicare and Medicaid Innovation developed four models of bundled payments and 48 discrete clinical condition episodes. Many surgical care procedures are included in the 48 different clinical condition episodes.

A Quantitative Analysis of the Relationship between Medicare Payment and Service Volume for Glaucoma Procedures from 2005 through 2009.

PubMed

Gong, Dan; Jun, Lin; Tsai, James C

2015-05-01

To calculate the association between Medicare payment and service volume for 6 commonly performed glaucoma procedures. Retrospective, longitudinal database study. A 100% dataset of all glaucoma procedures performed on Medicare Part B beneficiaries within the United States from 2005 to 2009. Fixed-effects regression model using Medicare Part B carrier data for all 50 states and the District of Columbia, controlling for time-invariant carrier-specific characteristics, national trends in glaucoma service volume, Medicare beneficiary population, number of ophthalmologists, and income per capita. Payment-volume elasticities, defined as the percent change in service volume per 1% change in Medicare payment, for laser trabeculoplasty (Current Procedural Terminology [CPT] code 65855), trabeculectomy without previous surgery (CPT code 66170), trabeculectomy with previous surgery (CPT code 66172), aqueous shunt to reservoir (CPT code 66180), laser iridotomy (CPT code 66761), and scleral reinforcement with graft (CPT code 67255). The payment-volume elasticity was nonsignificant for 4 of 6 procedures studied: laser trabeculoplasty (elasticity, -0.27; 95% confidence interval [CI], -1.31 to 0.77; P = 0.61), trabeculectomy without previous surgery (elasticity, -0.42; 95% CI, -0.85 to 0.01; P = 0.053), trabeculectomy with previous surgery (elasticity, -0.28; 95% CI, -0.83 to 0.28; P = 0.32), and aqueous shunt to reservoir (elasticity, -0.47; 95% CI, -3.32 to 2.37; P = 0.74). Two procedures yielded significant associations between Medicare payment and service volume. For laser iridotomy, the payment-volume elasticity was -1.06 (95% CI, -1.39 to -0.72; P < 0.001): for every 1% decrease in CPT code 66761 payment, laser iridotomy service volume increased by 1.06%. For scleral reinforcement with graft, the payment-volume elasticity was -2.92 (95% CI, -5.72 to -0.12; P = 0.041): for every 1% decrease in CPT code 67255 payment, scleral reinforcement with graft service volume increased by 2.92%. This study calculated the association between Medicare payment and service volume for 6 commonly performed glaucoma procedures and found varying magnitudes of payment-volume elasticities, suggesting that the volume response to changes in Medicare payments, if present, is not uniform across all Medicare procedures. Copyright © 2015 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

30 CFR 218.51 - How to make payments.

Code of Federal Regulations, 2010 CFR

2010-07-01

....O. Box 5640, Denver, CO 80217-5640. (3) For all other Federal and Indian lease payments other than... Management, P.O. Box 5810, Denver, CO 80217-5810. (e) Where to send a non-EFT payment when you use a courier or overnight delivery service. You should send this type of payment to: Minerals Management Service...

42 CFR 412.130 - Retroactive adjustments for incorrectly excluded hospitals and units.

Code of Federal Regulations, 2010 CFR

2010-10-01

..., DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Payments to Hospitals Under the Prospective Payment Systems § 412.130 Retroactive adjustments for... hospital that was excluded from the prospective payment systems specified in § 412.1(a)(1) or paid under...

42 CFR § 512.710 - Determination of CR incentive payments.

Code of Federal Regulations, 2010 CFR

2017-10-01

... SERVICES (CONTINUED) HEALTH CARE INFRASTRUCTURE AND MODEL PROGRAMS EPISODE PAYMENT MODEL CR Incentive Payment Model for EPM and Medicare Fee-for-Service Participants § 512.710 Determination of CR incentive... 42 Public Health 5 2017-10-01 2017-10-01 false Determination of CR incentive payments. § 512.710...

42 CFR 412.76 - Recovery of excess transition period payment amounts resulting from unlawful claims.

Code of Federal Regulations, 2010 CFR

2010-10-01

... & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM PROSPECTIVE PAYMENT SYSTEMS FOR... 42 Public Health 2 2010-10-01 2010-10-01 false Recovery of excess transition period payment... System for Inpatient Operating Costs § 412.76 Recovery of excess transition period payment amounts...

7 CFR 226.13 - Food service payments to sponsoring organizations for day care homes.

Code of Federal Regulations, 2010 CFR

2010-01-01

... day care homes. 226.13 Section 226.13 Agriculture Regulations of the Department of Agriculture... CARE FOOD PROGRAM Payment Provisions § 226.13 Food service payments to sponsoring organizations for day care homes. (a) Payments shall be made only to sponsoring organizations operating under an agreement...

How to buy a medical home? Policy options and practical questions.

PubMed

Berenson, Robert A; Rich, Eugene C

2010-06-01

In this paper, we describe a range of payment options to support the PCMH, identifying their conceptual strengths and weaknesses. These include enhanced FFS payment for office visits to the PCMH; paying additional FFS for "new" PCMH services; variations of traditional FFS combined with new PCMH-oriented per patient per month capitation; and combined capitation payments for traditional primary care medical services as well as new medical home services. In discussing options for PCMH payment reform we consider issues in patient severity adjustment, performance payment, and the role of payments to community service organizations to collaborate with the PCMH. We also highlight some of the practical challenges that can complicate reimbursement reform for primary care and the PCMH. Through this discussion we identify key dimensions to provider payment reform relevant to promoting enhanced primary care through the patient centered medical home. These consist of paying for the basic medical home services, rewarding excellent performance of medical homes, incentivizing medical home connections to other community health care resources, and overcoming implementation challenges to medical home payments. Each of these overarching policy issues invokes a substantial subset of policy relevant research questions that collectively comprise a robust research agenda. We conclude that the conceptual strengths and weaknesses of available payment models for medical home functions invoke a complex array of options with varying levels of real-world feasibility. The different needs of patients and communities, and varying characteristics of practices must also be factors guiding PCMH payment reform. Indeed, it may be that different circumstances will require different payment approaches in various combinations.

How to Buy a Medical Home? Policy Options and Practical Questions

PubMed Central

Berenson, Robert A.

2010-01-01

In this paper, we describe a range of payment options to support the PCMH, identifying their conceptual strengths and weaknesses. These include enhanced FFS payment for office visits to the PCMH; paying additional FFS for “new” PCMH services; variations of traditional FFS combined with new PCMH-oriented per patient per month capitation; and combined capitation payments for traditional primary care medical services as well as new medical home services. In discussing options for PCMH payment reform we consider issues in patient severity adjustment, performance payment, and the role of payments to community service organizations to collaborate with the PCMH. We also highlight some of the practical challenges that can complicate reimbursement reform for primary care and the PCMH. Through this discussion we identify key dimensions to provider payment reform relevant to promoting enhanced primary care through the patient centered medical home. These consist of paying for the basic medical home services, rewarding excellent performance of medical homes, incentivizing medical home connections to other community health care resources, and overcoming implementation challenges to medical home payments. Each of these overarching policy issues invokes a substantial subset of policy relevant research questions that collectively comprise a robust research agenda. We conclude that the conceptual strengths and weaknesses of available payment models for medical home functions invoke a complex array of options with varying levels of real-world feasibility. The different needs of patients and communities, and varying characteristics of practices must also be factors guiding PCMH payment reform. Indeed, it may be that different circumstances will require different payment approaches in various combinations. PMID:20467911

Mobilization for HIV Voluntary Counseling and Testing Services in Vietnam: Clients' Risk Behaviors, Attitudes and Willingness to Pay.

PubMed

Nguyen, Long Hoang; Tran, Bach Xuan; Nguyen, Nhung Phuong; Phan, Huong Thu Thi; Bui, Trang Thu; Latkin, Carl A

2016-04-01

A multi-site survey was conducted on a sample of 365 clients to assess their willingness to pay for HIV voluntary counseling and testing (VCT) services in Ha Noi and Nam Dinh province, two epicenters of Vietnam. By using contingent valuation technique, the results showed that most of respondents (95.1 %) were willing to pay averagely 155 (95 % CI 132-177) thousands Vietnam Dong (~US $7.75, 2013) for a VCT service. Clients who were female, had middle income level, and current opioid users were willing to pay less; meanwhile clients who had university level of education were willing to pay more for a VCT service. The results highlighted the high rate of willingness to pay for the service at a high amount by VCT clients. These findings contribute to the implementation of co-payment scheme for VCT services toward the financial sustainability of HIV/AIDS programs in Vietnam.

42 CFR § 414.1335 - Data submission criteria for the quality performance category.

Code of Federal Regulations, 2010 CFR

2017-10-01

..., DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM (CONTINUED) PAYMENT FOR PART B MEDICAL AND OTHER HEALTH SERVICES Merit-Based Incentive Payment System and Alternative Payment Model Incentive...

76 FR 44573 - Child and Adult Care Food Program: National Average Payment Rates, Day Care Home Food Service...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-07-26

... DEPARTMENT OF AGRICULTURE Food and Nutrition Service Child and Adult Care Food Program: National Average Payment Rates, Day Care Home Food Service Payment Rates, and Administrative Reimbursement Rates for Sponsoring Organizations of Day Care Homes for the Period July 1, 2011 Through June 30, 2012...

38 CFR 17.1000 - Payment or reimbursement for emergency services for nonservice-connected conditions in non-VA...

Code of Federal Regulations, 2010 CFR

2010-07-01

... for emergency services for nonservice-connected conditions in non-VA facilities. 17.1000 Section 17.1000 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Payment Or Reimbursement for Emergency Services for Nonservice-Connected Conditions in Non-Va Facilities § 17.1000 Payment...

14 CFR 399.86 - Payments for non-air transportation services for air cargo.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 14 Aeronautics and Space 4 2010-01-01 2010-01-01 false Payments for non-air transportation... Enforcement § 399.86 Payments for non-air transportation services for air cargo. The Board considers that... air carriers for non-air transportation preparation of air cargo shipments are for services ancillary...

78 FR 45176 - Child and Adult Care Food Program: National Average Payment Rates, Day Care Home Food Service...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-07-26

... DEPARTMENT OF AGRICULTURE Food and Nutrition Service Child and Adult Care Food Program: National Average Payment Rates, Day Care Home Food Service Payment Rates, and Administrative Reimbursement Rates for Sponsoring Organizations of Day Care Homes for the Period July 1, 2013 Through June 30, 2014...

76 FR 43254 - Child and Adult Care Food Program: National Average Payment Rates, Day Care Home Food Service...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-07-20

... DEPARTMENT OF AGRICULTURE Food and Nutrition Service Child and Adult Care Food Program: National Average Payment Rates, Day Care Home Food Service Payment Rates, and Administrative Reimbursement Rates for Sponsoring Organizations of Day Care Homes for the Period July 1, 2011 Through June 30, 2012...

20 CFR 404.1576 - Impairment-related work expenses.

Code of Federal Regulations, 2010 CFR

2010-04-01

... enable you to work, we will deduct payments you make toward its cost. (5) Payments for drugs and medical services. (i) If you must use drugs or medical services (including diagnostic procedures) to control your impairment(s) the payments you make for them may be deducted. The drugs or services must be prescribed (or...

42 CFR 413.122 - Payment for hospital outpatient radiology services and other diagnostic procedures.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 2 2010-10-01 2010-10-01 false Payment for hospital outpatient radiology services... radiology services and other diagnostic procedures. (a) Basis and purpose. (1) This section implements section 1833(n) of the Act and establishes the method for determining Medicare payments for radiology...

Wide variation in payments for Medicare beneficiary oncology services suggests room for practice-level improvement.

PubMed

Clough, Jeffrey D; Patel, Kavita; Riley, Gerald F; Rajkumar, Rahul; Conway, Patrick H; Bach, Peter B

2015-04-01

In recent years many policy makers have recommended alternative payment models in medical oncology in order to reduce costs and improve patient outcomes. Yet information on how oncology practices differ in their use of key service categories is limited. We measured annual payments for key service categories delivered to fee-for-service Medicare beneficiaries receiving care from 1,534 medical oncology practices in 2011-12. In 2012, differences in payments per beneficiary at the seventy-fifth-percentile practice compared to the twenty-fifth-percentile practice were $3,866 for chemotherapy (including administration and supportive care drugs), $1,872 for acute medical hospitalizations, and $439 for advanced imaging. Supportive care drugs, bevacizumab, and positron-emission tomography accounted for the greatest percentage of variation. Average practice payments for service categories were highly correlated across years but not correlated with each other, which suggests that service categories may be affected by different physician practice characteristics. These differences, even when clinical guidelines exist, demonstrate the potential for quality improvement that could be accelerated through alternative payment models. Project HOPE—The People-to-People Health Foundation, Inc.

Two Wrongs Do Not Make a Right: Flaws in Alternatives to Fee-for-Service Payment Plans Do Not Mean Fee-for-Service Is a Good Solution to Rising Prices Comment on "Fee-for-Service Payment - An Evil Practice That Must Be Stamped Out?".

PubMed

Koppel, Ross

2015-05-11

Professor Naoki Ikegami's "Fee-for-service payment - an evil practice that must be stamped out" summarizes many of the failings of alternatives to fee-for-service (FFS) payment systems. His article also offers several suggestions for improving FFS systems. However, even powerful arguments against many of the alternatives to FFS, does not make a convincing argument for FFS systems. In addition, there are significant misunderstandings in Professor Ikegami's presentation of and use of United States payment methods, the role of private vs. public insurance systems, and the increasing role of "accountable care organizations. © 2015 by Kerman University of Medical Sciences.

Bundling Post-Acute Care Services into MS-DRG Payments

PubMed Central

Vertrees, James C.; Averill, Richard F.; Eisenhandler, Jon; Quain, Anthony; Switalski, James

2013-01-01

Objective A bundled hospital payment system that encompasses both acute and post-acute care has been proposed as a means of creating financial incentives in the Medicare fee-for-service system to foster care coordination and to improve the current disorganized system of post care. The objective of this study was to evaluate the statistical stability of alternative designs of a hospital payment system that includes post-acute care services to determine the feasibility of using a combined hospital and post-acute care bundle as a unit of payment. Methods The Medicare Severity-Diagnosis Related Groups (MS-DRGs) were subdivided into clinical subclasses that measured a patient's chronic illness burden to test whether a patient's chronic illness burden had a substantial impact on post-acute care expenditures. Using Medicare data the statistical performance of the MS-DRGs with and without the chronic illness subclasses was evaluated across a wide range of post-acute care windows and combinations of post-acute care service bundles using both submitted charges and Medicare payments. Results The statistical performance of the MS-DRGs as measured by R2 was consistently better when the chronic illness subclasses are included indicating that MS-DRGs by themselves are an inadequate unit of payment for post-acute care payment bundles. In general, R2 values increased as the post-acute care window length increased and decreased as more services were added to the post-acute care bundle. Discussion The study results suggest that it is feasible to develop a payment system that incorporates significant post-acute care services into the MS-DRG inpatient payment bundle. This expansion of the basic DRG payment approach can provide a strong financial incentive for providers to better coordinate care potentially leading to improved efficiency and outcome quality. PMID:24753970

The impact of physician payment methods on raising the efficiency of the healthcare system: an international comparison.

PubMed

Simoens, Steven; Giuffrida, Antonio

2004-01-01

This article reviews policies on physician payment methods that Organisation for Economic Cooperation and Development (OECD) countries have implemented to promote an efficient deployment of physicians. Countries' experiences show that payment by fee-for-service, capitation and salary influences physician activity levels and productivity. However, the impact of these simple payment methods is complex and may be diluted by clinical, demographic, ethical and organisational factors. Policies that have attempted to curb health expenditure by controlling fee levels have sometimes been eroded by physicians increasing the volume of service supply, or providing services that attract higher fees. Flexible blended payment methods based on the combination of a fixed component, through either capitation or salary, and a variable component, through fee-for-service, may produce a desirable mix of incentives. Integrating such blended payment methods with mechanisms to monitor physician activity may offer potential success.

Medicare program; prospective payment system for hospital outpatient services--HCFA. Proposed rule.

PubMed

1998-09-08

As required by sections 4521, 4522, and 4523 of the Balanced Budget Act of 1997, this proposed rule would eliminate the formula-driven overpayment for certain outpatient hospital services, extend reductions in payment for costs of hospital outpatient services, and establish in regulations a prospective payment system for hospital outpatient services (and for Medicare Part B services furnished to inpatients who have no Part A coverage). The prospective payment system would simplify our current payment system and apply to all hospitals, including those that are excluded from the inpatient prospective payment system. The Balanced Budget Act provides for implementation of the prospective payment system effective January 1, 1999, but delays application of the system to cancer hospitals until January 1, 2000. The hospital outpatient prospective payment system would also apply to partial hospitalization services furnished by community mental health centers. Although the statutory effective date for the outpatient prospective payment system is January 1, 1999, implementation of the new system will have to be delayed because of year 2000 systems concerns. The demands on intermediary bill processing systems and HCFA internal systems to become compliant for the year 2000 preclude making the major systems changes that are required to implement the prospective payment system. The outpatient prospective payment system will be implemented for all hospitals and community mental health centers as soon as possible after January 1, 2000, and a notice of the anticipated implementation date will be published in the Federal Register at least 90 days in advance. This document also proposes new requirements for provider departments and provider-based entities. These proposed changes, as revised based on our consideration of public comments, will be effective 30 days after publication of a final rule. This proposed rule would also implement section 9343(c) of the Omnibus Budget Reconciliation Act of 1986, which prohibits Medicare payment for nonphysician services furnished to a hospital outpatient by a provider or supplier other than a hospital, unless the services are furnished under an arrangement with the hospital. This section also authorizes the Department of Health and Human Services' Office of Inspector General to impose a civil money penalty, not to exceed $10,000, against any individual or entity who knowingly and willfully presents a bill for nonphysician or other bundled services not provided directly or under such an arrangement. This proposed rule also addresses the requirements for designating certain entities as provider-based or as a department of a hospital.

42 CFR 415.110 - Conditions for payment: Medically directed anesthesia services.

Code of Federal Regulations, 2011 CFR

2011-10-01

... anesthesia services. 415.110 Section 415.110 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES... directed anesthesia services. (a) General payment rule. Medicare pays for the physician's medical direction of anesthesia services for one service or two through four concurrent anesthesia services furnished...

42 CFR 415.110 - Conditions for payment: Medically directed anesthesia services.

Code of Federal Regulations, 2010 CFR

2010-10-01

... anesthesia services. 415.110 Section 415.110 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES... directed anesthesia services. (a) General payment rule. Medicare pays for the physician's medical direction of anesthesia services for one service or two through four concurrent anesthesia services furnished...

42 CFR § 484.325 - Payments for home health services under Home Health Value-Based Purchasing (HHVBP) Model.

Code of Federal Regulations, 2010 CFR

2017-10-01

... Purchasing (HHVBP) Model. CMS will determine a payment adjustment up to the maximum applicable percentage... Total Performance Score using a linear exchange function. Payment adjustments made under the HHVBP Model... 42 Public Health 5 2017-10-01 2017-10-01 false Payments for home health services under Home Health...

42 CFR § 484.325 - Payments for home health services under Home Health Value-Based Purchasing (HHVBP) Model.

Code of Federal Regulations, 2010 CFR

2016-10-01

... Purchasing (HHVBP) Model. CMS will determine a payment adjustment up to the maximum applicable percentage... Total Performance Score using a linear exchange function. Payment adjustments made under the HHVBP Model... 42 Public Health 5 2016-10-01 2016-10-01 false Payments for home health services under Home Health...

42 CFR 413.118 - Payment for facility services related to covered ASC surgical procedures performed in hospitals...

Code of Federal Regulations, 2010 CFR

2010-10-01

... establishes the method for determining Medicare payments for services related to covered ambulatory surgical... deductibles and coinsurance; or (2) The blended payment amount as described in paragraph (d) of this section...) Blended payment amount. (1) For cost reporting periods beginning on or after October 1, 1987 but before...

Mastering Mobile Security

ERIC Educational Resources Information Center

Panettieri, Joseph C.

2007-01-01

Without proper security, mobile devices are easy targets for worms, viruses, and so-called robot ("bot") networks. Hackers increasingly use bot networks to launch massive attacks against eCommerce websites--potentially targeting one's online tuition payment or fundraising/financial development systems. How can one defend his mobile systems against…

20 CFR 404.2114 - Services for which payment may be made.

Code of Federal Regulations, 2011 CFR

2011-04-01

... Services for which payment may be made. (a) General. Payment may be made for VR services provided by a State VR agency in accordance with title I of the Rehabilitation Act of 1973, as amended, or by an alternate participant under a negotiated plan, subject to the limitations and conditions in this subpart. VR...

20 CFR 404.2114 - Services for which payment may be made.

Code of Federal Regulations, 2010 CFR

2010-04-01

... Services for which payment may be made. (a) General. Payment may be made for VR services provided by a State VR agency in accordance with title I of the Rehabilitation Act of 1973, as amended, or by an alternate participant under a negotiated plan, subject to the limitations and conditions in this subpart. VR...

29 CFR 1610.15 - Schedule of fees and method of payment for services rendered.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 29 Labor 4 2010-07-01 2010-07-01 false Schedule of fees and method of payment for services... of fees and method of payment for services rendered. (a) Fees shall be assessed in accordance with... request is made by an educational or noncommercial scientific institution, or a representative of the news...

42 CFR 405.350 - Individual's liability for payments made to providers and other persons for items and services...

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 2 2010-10-01 2010-10-01 false Individual's liability for payments made to... Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM FEDERAL HEALTH INSURANCE FOR THE AGED AND DISABLED Suspension of Payment, Recovery of Overpayments, and...

42 CFR 405.350 - Individual's liability for payments made to providers and other persons for items and services...

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 2 2011-10-01 2011-10-01 false Individual's liability for payments made to... Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM FEDERAL HEALTH INSURANCE FOR THE AGED AND DISABLED Suspension of Payment, Recovery of Overpayments, and...

42 CFR 422.216 - Special rules for MA private fee-for-service plans.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 42 Public Health 3 2013-10-01 2013-10-01 false Special rules for MA private fee-for-service plans... With Providers § 422.216 Special rules for MA private fee-for-service plans. (a) Payment to providers—(1) Payment rate. (i) The MA organization must establish payment rates for plan covered items and...

42 CFR 422.216 - Special rules for MA private fee-for-service plans.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 3 2014-10-01 2014-10-01 false Special rules for MA private fee-for-service plans... With Providers § 422.216 Special rules for MA private fee-for-service plans. (a) Payment to providers—(1) Payment rate. (i) The MA organization must establish payment rates for plan covered items and...

42 CFR 422.216 - Special rules for MA private fee-for-service plans.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 3 2012-10-01 2012-10-01 false Special rules for MA private fee-for-service plans... With Providers § 422.216 Special rules for MA private fee-for-service plans. (a) Payment to providers—(1) Payment rate. (i) The MA organization must establish payment rates for plan covered items and...

20 CFR 404.2114 - Services for which payment may be made.

Code of Federal Regulations, 2014 CFR

2014-04-01

... Services for which payment may be made. (a) General. Payment may be made for VR services provided by a State VR agency in accordance with title I of the Rehabilitation Act of 1973, as amended, or by an alternate participant under a negotiated plan, subject to the limitations and conditions in this subpart. VR...

20 CFR 404.2114 - Services for which payment may be made.

Code of Federal Regulations, 2012 CFR

2012-04-01

... Services for which payment may be made. (a) General. Payment may be made for VR services provided by a State VR agency in accordance with title I of the Rehabilitation Act of 1973, as amended, or by an alternate participant under a negotiated plan, subject to the limitations and conditions in this subpart. VR...

20 CFR 404.2114 - Services for which payment may be made.

Code of Federal Regulations, 2013 CFR

2013-04-01

... Services for which payment may be made. (a) General. Payment may be made for VR services provided by a State VR agency in accordance with title I of the Rehabilitation Act of 1973, as amended, or by an alternate participant under a negotiated plan, subject to the limitations and conditions in this subpart. VR...

31 CFR 500.585 - Payments for services rendered by North Korea to United States aircraft authorized.

Code of Federal Regulations, 2010 CFR

2010-07-01

... North Korea to United States aircraft authorized. 500.585 Section 500.585 Money and Finance: Treasury... § 500.585 Payments for services rendered by North Korea to United States aircraft authorized. Payments to North Korea of charges for services rendered by the Government of North Korea in connection with...

42 CFR 405.515 - Reimbursement for clinical laboratory services billed by physicians.

Code of Federal Regulations, 2012 CFR

2012-10-01

...'s bill, or a request for payment for a physician's services, includes a charge for a laboratory test... chapter): (a) If the bill or request for payment indicates that the test was personally performed or supervised either by the physician who submitted the bill (or for whose services the request for payment was...

42 CFR 405.515 - Reimbursement for clinical laboratory services billed by physicians.

Code of Federal Regulations, 2011 CFR

2011-10-01

...'s bill, or a request for payment for a physician's services, includes a charge for a laboratory test... chapter): (a) If the bill or request for payment indicates that the test was personally performed or supervised either by the physician who submitted the bill (or for whose services the request for payment was...

42 CFR 405.515 - Reimbursement for clinical laboratory services billed by physicians.

Code of Federal Regulations, 2013 CFR

2013-10-01

...'s bill, or a request for payment for a physician's services, includes a charge for a laboratory test... chapter): (a) If the bill or request for payment indicates that the test was personally performed or supervised either by the physician who submitted the bill (or for whose services the request for payment was...

42 CFR 405.515 - Reimbursement for clinical laboratory services billed by physicians.

Code of Federal Regulations, 2014 CFR

2014-10-01

...'s bill, or a request for payment for a physician's services, includes a charge for a laboratory test... chapter): (a) If the bill or request for payment indicates that the test was personally performed or supervised either by the physician who submitted the bill (or for whose services the request for payment was...

Diagnosis-related group (DRG)-based case-mix funding system, a promising alternative for fee for service payment in China.

PubMed

Zhao, Cuirong; Wang, Chao; Shen, Chengwu; Wang, Qian

2018-05-13

Fee for services (FFS) is the prevailing method of payment in most Chinese public hospitals. Under this retrospective payment system, medical care providers are paid based on medical services and tend to over-treat to maximize their income, thereby contributing to rising medical costs and uncontrollable health expenditures to a large extent. Payment reform needs to be promptly implemented to move to a prospective payment plan. The diagnosis-related group (DRG)-based case-mix payment system, with its superior efficiency and containment of costs, has garnered increased attention and it represents a promising alternative. This article briefly describes the DRG-based case-mix payment system, it comparatively analyzes differences between FFS and case-mix funding systems, and it describes the implementation of DRGs in China. China's social and economic conditions differ across regions, so establishment of a national payment standard will take time and involve difficulties. No single method of provider payment is perfect. Measures to monitor and minimize the negative ethical implications and unintended effects of a DRG-based case-mix payment system are essential to ensuring the lasting social benefits of payment reform in Chinese public hospitals.

42 CFR 412.80 - Outlier cases: General provisions.

Code of Federal Regulations, 2010 CFR

2010-10-01

... payments and beyond additional payments for new medical services or technology specified in §§ 412.87 and..., Special Treatment Payment for New Technology, and Payment Adjustment for Certain Replaced Devices Payment... payment for the case, payments for indirect costs of graduate medical education (§ 412.105), and payments...

Medicaid program; modification of the Medicaid upper payment limit transition period for inpatient hospital services, outpatient hospital services, nursing facility services, intermediate care facility services for the mentally retarded, and clinic services. Final rule.

PubMed

2001-09-05

This final rule modifies the Medicaid upper payment (UPL) limit provisions by establishing a new transition period for States that submitted plan amendments before March 13, 2001 that do not comply with the new UPLs effective on that date (but do comply with the prior UPLs) and were approved on or after January 22, 2001. This new transition period applies to payments for inpatient hospital services, outpatient hospital services, nursing facility services, intermediate care facility services for the mentally retarded, and clinic services.

A Truthful Incentive Mechanism for Online Recruitment in Mobile Crowd Sensing System

PubMed Central

Chen, Xiao; Liu, Min; Zhou, Yaqin; Li, Zhongcheng; Chen, Shuang; He, Xiangnan

2017-01-01

We investigate emerging mobile crowd sensing (MCS) systems, in which new cloud-based platforms sequentially allocate homogenous sensing jobs to dynamically-arriving users with uncertain service qualities. Given that human beings are selfish in nature, it is crucial yet challenging to design an efficient and truthful incentive mechanism to encourage users to participate. To address the challenge, we propose a novel truthful online auction mechanism that can efficiently learn to make irreversible online decisions on winner selections for new MCS systems without requiring previous knowledge of users. Moreover, we theoretically prove that our incentive possesses truthfulness, individual rationality and computational efficiency. Extensive simulation results under both real and synthetic traces demonstrate that our incentive mechanism can reduce the payment of the platform, increase the utility of the platform and social welfare. PMID:28045441

Cost savings associated with an alternative payment model for integrating behavioral health in primary care.

PubMed

Ross, Kaile M; Gilchrist, Emma C; Melek, Stephen P; Gordon, Patrick D; Ruland, Sandra L; Miller, Benjamin F

2018-05-23

Financially supporting and sustaining behavioral health services integrated into primary care settings remains a major barrier to widespread implementation. Sustaining Healthcare Across Integrated Primary Care Efforts (SHAPE) was a demonstration project designed to prospectively examine the cost savings associated with utilizing an alternative payment methodology to support behavioral health services in primary care practices with integrated behavioral health services. Six primary care practices in Colorado participated in this project. Each practice had at least one on-site behavioral health clinician providing integrated behavioral health services. Three practices received non-fee-for-service payments (i.e., SHAPE payment) to support provision of behavioral health services for 18 months. Three practices did not receive the SHAPE payment and served as control practices for comparison purposes. Assignment to condition was nonrandom. Patient claims data were collected for 9 months before the start of the SHAPE demonstration project (pre-period) and for 18 months during the SHAPE project (post-period) to evaluate cost savings. During the 18-month post-period, analysis of the practices' claims data demonstrated that practices receiving the SHAPE payment generated approximately $1.08 million in net cost savings for their public payer population (i.e., Medicare, Medicaid, and Dual Eligible; N = 9,042). The cost savings were primarily achieved through reduction in downstream utilization (e.g., hospitalizations). The SHAPE demonstration project found that non-fee-for-service payments for behavioral health integrated into primary care may be associated with significant cost savings for public payers, which could have implications on future delivery and payment work in public programs (e.g., Medicaid).

Out-of-pocket payments for health care services in Bulgaria: financial burden and barrier to access.

PubMed

Atanasova, Elka; Pavlova, Milena; Moutafova, Emanuela; Rechel, Bernd; Groot, Wim

2013-12-01

In recent years, Bulgaria has increasingly relied on out-of-pocket payments as one of the main sources of health care financing. However, it is largely unknown whether the official patient charges, combined with informal payments, are affordable for the population. Our study aimed to explore the scale of out-of-pocket payments for health care services and their affordability. Data were collected in two nationally representative surveys, conducted in Bulgaria in 2010 and 2011, using face-to-face interviews based on a standardized questionnaire. To select respondents, a multi-stage random probability method was used. The questionnaire included questions on the out-of-pocket payments for health care services used by the respondent during the preceding 12 months. In total, 75.7% (2010) and 84.0% (2011) of outpatient service users reported to have paid out-of-pocket, with 12.6% (2010) and 9.7% (2011) of users reporting informal payments. Of those who had used inpatient services, 66.5% (2010) and 63.1% (2011) reported to have made out-of-pocket payments, with 31.8% (2010) and 18.3% (2011) reporting to have paid informally. We found large inability to pay indicated by the need to borrow money and/or forego services. Regression analysis showed that the inability to pay is especially pronounced among those with poor health status and chronic diseases and those on low household incomes. The high level of both formal and informal out-of-pocket payments for health care services in Bulgaria poses a considerable burden for households and undermines access to health services for poorer parts of the population.

A comparison of mail-service and retail community pharmacy claims in 5 prescription benefit plans.

PubMed

Clark, Bartholomew E; Siracuse, Mark V; Garis, Robert I

2009-06-01

Little evidence has been presented to date that would either support or refute a widely held belief that mail-service pharmacy utilization routinely produces savings in drug benefit costs for prescription benefit plan sponsors. To present a comparative analysis of mail-service and community pharmacy service drug benefit costs for 5 employer-sponsored prescription drug benefit plans. A cross-sectional comparison of 17,725 matched transaction pairs of community and mail-service prescriptions from a data set comprised 484,987 prescription claims from a convenience sample of 5 employer-sponsored prescription benefit plans. Differences between community pharmacy and mail-service prescription transactions were examined at the per-unit level of analysis for drug ingredient costs, dispensing fees, co-payments, dollar amounts paid by plan sponsor, and total dollar amounts. Overall, the total cost of prescriptions was lower through mail-service pharmacies for all 5 plans studied. Two of 5 plans had co-payment incentives to use mail-service, yet plan sponsors paid more for mail-service drugs; respectively, 4.5% and 8.3% more overall, 25.0% and 21.4% more for generic medications; and 3.0% and 7.0% more for brand name medications. Mail-service co-payments were 48.9% and 51.7% lower. Mail-service utilization rates were 15.2% and 31.5% of the total number of prescriptions dispensed in the period studied. Three of 5 plans had no co-payment incentive to use mail-service and paid less for mail-service drugs; respectively, 18.7%, 6.6%, and 15.7% less overall; 17.4%, 15.6%, and 7.9% less for generic medications; and 18.8%, 5.2%, and 16.6% less for brand name medications. Mail-service co-payments were 10.5% more, 5.2% less, and 1.8% more than community pharmacy co-payments, respectively. Mail-service utilization rates were 0.8%, 1.2%, and 4.4%. Co-payment incentives to use mail-service pharmacies instead of community pharmacies were associated with higher mail-service utilization rates and with higher costs to plan sponsors. Absence of a co-payment incentive to use mail-service pharmacies was associated with lower mail-service utilization rates and with lower costs to plan sponsors.

42 CFR 424.124 - Conditions for payment for physician services and ambulance services.

Code of Federal Regulations, 2010 CFR

2010-10-01

..., DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM CONDITIONS FOR MEDICARE PAYMENT Special... connection with covered inpatient hospital services; and (2) They meet the conditions set forth in paragraphs...

42 CFR 424.124 - Conditions for payment for physician services and ambulance services.

Code of Federal Regulations, 2011 CFR

2011-10-01

..., DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM CONDITIONS FOR MEDICARE PAYMENT Special... connection with covered inpatient hospital services; and (2) They meet the conditions set forth in paragraphs...

76 FR 81942 - Federal Acquisition Regulation; Information Collection; Progress Payments (SF-1443)

Federal Register 2010, 2011, 2012, 2013, 2014

2011-12-29

...; Information Collection; Progress Payments (SF-1443) AGENCIES: Department of Defense (DOD), General Services... DEPARTMENT OF DEFENSE GENERAL SERVICES ADMINISTRATION NATIONAL AERONAUTICS AND SPACE... requirement concerning progress payments. Public comments are particularly invited on: Whether this collection...

7 CFR 4288.131 - Payment provisions.

Code of Federal Regulations, 2014 CFR

2014-01-01

... RURAL UTILITIES SERVICE, DEPARTMENT OF AGRICULTURE PAYMENT PROGRAMS Advanced Biofuel Payment Program General Provisions Payment Provisions § 4288.131 Payment provisions. Payments to advanced biofuel producers for eligible advanced biofuel production will be determined in accordance with the provisions of...

U.S. Minority Homeless Youth's Access to and Use of Mobile Phones: Implications for mHealth Intervention Design.

PubMed

Jennings, Larissa; Lee, Nicole; Shore, Deborah; Strohminger, Nancy; Allison, Burgundi; Conserve, Donaldson F; Cheskin, Lawrence J

2016-07-01

Few interventions for homeless youth have leveraged the potential of mHealth technologies, in part because of the limited data on phone behaviors, perceptions, and intervention preferences among youth experiencing homelessness. We conducted 9 focus groups (n = 52 homeless youth) and 41 individual structured interviews also with homeless youth in underserved communities in Baltimore and Washington, DC, to ascertain how youth perceived their mobile phone, acquired and maintained mobile services over time, and thought mHealth programs for this population should be designed. We also measured phone use, functionality, source, duration of ownership, and reasons for changing phones or numbers. Results showed that mobile coverage was high, as most youth self-purchased phones or received gift payments from others. Maintaining mobile connectivity was often challenging because of financial constraints and interpersonal conflict. Youth valued phones to access social support but used several tactics to avoid perceived negative consequences of phone ownership, such as harassment, theft, or relational disputes. Youth most preferred mHealth content relating to sexual, reproductive, and mental health provided that mobile communication was confidential, empowering, and integrated with other digital media. Integrating hidden phones, financial support, and safety management may improve homeless youth's access to and engagement with mHealth strategies over time.

Informal payments in the Greek health sector amid the financial crisis: old habits die last...

PubMed

Souliotis, Kyriakos; Golna, Christina; Tountas, Yannis; Siskou, Olga; Kaitelidou, Daphne; Liaropoulos, Lycourgos

2016-03-01

Under-the-table informal payments are commonplace as reimbursements for health care services in Greece. As the country faces a severe financial crisis, the need to investigate the extent of such payments, their incidence and their impact on household income is pressing. A survey of 2,741 persons from across the country was conducted between December 2011 and February 2012. The sample was defined via a multistage selection process using a quota for municipality of residence, sex and age. The maximum error margin was 2.41% with a confidence interval of 95%. The survey reports under-the-table payments for approximately 32.4% of public hospital admissions. Private clinics, which display the bulk of out-of-pocket payments, naturally display the lowest under-the-table payments. The highest percentage of under-the-table payments in the private sector appears at visits to private practitioners and dentists (36%). Informal payments are most frequently made upon request, prior to service provision, to facilitate access to care and to reduce waiting times, and at a much lower percentage, to post-service provision, and out of gratitude. This survey reveals that, due to severe financial pressure, there is a growing unwillingness of citizens to pay informally and an increasing demand for these payments as a prerequisite for access to services or to redeem services provided. This "hidden" financial burden of at least 27% impacts negatively on the living conditions of households and is not reported as purchasing ability or cost of living.

42 CFR 442.12 - Provider agreement: General requirements.

Code of Federal Regulations, 2014 CFR

2014-10-01

... SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS STANDARDS FOR PAYMENT TO NURSING FACILITIES AND... nursing facility services nor make Medicaid payments to a facility for those services unless the Secretary...

26 CFR 1.164-8 - Payments for municipal services in atomic energy communities.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 26 Internal Revenue 2 2013-04-01 2013-04-01 false Payments for municipal services in atomic energy... Corporations § 1.164-8 Payments for municipal services in atomic energy communities. (a) General. For taxable... any community (as defined in section 21b of the Atomic Energy Community Act of 1955 (42 U.S.C. 2304...

26 CFR 1.164-8 - Payments for municipal services in atomic energy communities.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 26 Internal Revenue 2 2010-04-01 2010-04-01 false Payments for municipal services in atomic energy... Corporations § 1.164-8 Payments for municipal services in atomic energy communities. (a) General. For taxable... any community (as defined in section 21b of the Atomic Energy Community Act of 1955 (42 U.S.C. 2304...

26 CFR 1.164-8 - Payments for municipal services in atomic energy communities.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 26 Internal Revenue 2 2011-04-01 2011-04-01 false Payments for municipal services in atomic energy... Corporations § 1.164-8 Payments for municipal services in atomic energy communities. (a) General. For taxable... any community (as defined in section 21b of the Atomic Energy Community Act of 1955 (42 U.S.C. 2304...

26 CFR 1.164-8 - Payments for municipal services in atomic energy communities.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 26 Internal Revenue 2 2012-04-01 2012-04-01 false Payments for municipal services in atomic energy... Corporations § 1.164-8 Payments for municipal services in atomic energy communities. (a) General. For taxable... any community (as defined in section 21b of the Atomic Energy Community Act of 1955 (42 U.S.C. 2304...

26 CFR 1.164-8 - Payments for municipal services in atomic energy communities.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 26 Internal Revenue 2 2014-04-01 2014-04-01 false Payments for municipal services in atomic energy... Corporations § 1.164-8 Payments for municipal services in atomic energy communities. (a) General. For taxable... any community (as defined in section 21b of the Atomic Energy Community Act of 1955 (42 U.S.C. 2304...

42 CFR 413.125 - Payment for home health agency services.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 2 2011-10-01 2011-10-01 false Payment for home health agency services. 413.125... Categories of Costs § 413.125 Payment for home health agency services. (a) For additional rules on the allowability of certain costs incurred by home health agencies, see §§ 409.46 and 409.49(b) of this chapter. (b...

42 CFR 413.125 - Payment for home health agency services.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 2 2012-10-01 2012-10-01 false Payment for home health agency services. 413.125... Categories of Costs § 413.125 Payment for home health agency services. (a) For additional rules on the allowability of certain costs incurred by home health agencies, see §§ 409.46 and 409.49(b) of this chapter. (b...

42 CFR 413.125 - Payment for home health agency services.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 42 Public Health 2 2013-10-01 2013-10-01 false Payment for home health agency services. 413.125... Categories of Costs § 413.125 Payment for home health agency services. (a) For additional rules on the allowability of certain costs incurred by home health agencies, see §§ 409.46 and 409.49(b) of this chapter. (b...

22 CFR 19.4 - Special rules for computing creditable service for purposes of payments to former spouses.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 22 Foreign Relations 1 2010-04-01 2010-04-01 false Special rules for computing creditable service for purposes of payments to former spouses. 19.4 Section 19.4 Foreign Relations DEPARTMENT OF STATE... DISABILITY SYSTEM § 19.4 Special rules for computing creditable service for purposes of payments to former...

7 CFR 1951.9 - Distribution of payments when a borrower owes more than one type of FmHA or its successor agency...

Code of Federal Regulations, 2010 CFR

2010-01-01

...-COOPERATIVE SERVICE, RURAL UTILITIES SERVICE, AND FARM SERVICE AGENCY, DEPARTMENT OF AGRICULTURE (CONTINUED... Public Law 103-354 loans. In making such distribution consider the principal balance outstanding on each...) Application of payments. After the decision is reached as to the amount of each payment that is to be...

42 CFR 412.110 - Total Medicare payment.

Code of Federal Regulations, 2010 CFR

2010-10-01

... PROGRAM PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Payments to Hospitals Under the Prospective Payment Systems § 412.110 Total Medicare payment. Under the prospective payment systems, Medicare... 42 Public Health 2 2010-10-01 2010-10-01 false Total Medicare payment. 412.110 Section 412.110...

42 CFR 412.115 - Additional payments.

Code of Federal Regulations, 2010 CFR

2010-10-01

... PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Payments to Hospitals Under the Prospective Payment Systems § 412.115 Additional payments. (a) Bad debts. An additional payment is made to each... 42 Public Health 2 2010-10-01 2010-10-01 false Additional payments. 412.115 Section 412.115 Public...

Episodic payments (bundling): PART I.

PubMed

Jacofsky, D J

2017-10-01

Episodic, or bundled payments, is a concept now familiar to most in the healthcare arena, but the models are often misunderstood. Under a traditional fee-for-service model, each provider bills separately for their services which creates financial incentives to maximise volumes. Under a bundled payment, a single entity, often referred to as a convener (maybe the hospital, the physician group, or a third party) assumes the risk through a payer contract for all services provided within a defined episode of care, and receives a single (bundled) payment for all services provided for that episode. The time frame around the intervention is variable, but defined in advance, as are included and excluded costs. Timing of the actual payment in a bundle may either be before the episode occurs (prospective payment model), or after the end of the episode through a reconciliation (retrospective payment model). In either case, the defined costs over the defined time frame are borne by the convener. Cite this article: Bone Joint J 2017;99-B:1280-5. ©2017 The British Editorial Society of Bone & Joint Surgery.

7 CFR 4288.113 - Payment record requirements.

Code of Federal Regulations, 2013 CFR

2013-01-01

... SERVICE AND RURAL UTILITIES SERVICE, DEPARTMENT OF AGRICULTURE PAYMENT PROGRAMS Advanced Biofuel Payment... advanced biofuel producer must maintain records for all relevant fiscal years and fiscal year quarters for each advanced biofuel facility indicating: (a) The type of eligible renewable biomass used in the...

7 CFR 4288.113 - Payment record requirements.

Code of Federal Regulations, 2012 CFR

2012-01-01

... SERVICE AND RURAL UTILITIES SERVICE, DEPARTMENT OF AGRICULTURE PAYMENT PROGRAMS Advanced Biofuel Payment... advanced biofuel producer must maintain records for all relevant fiscal years and fiscal year quarters for each advanced biofuel facility indicating: (a) The type of eligible renewable biomass used in the...

77 FR 19287 - Federal Acquisition Regulation; Submission for OMB Review; Progress Payments (SF-1443)

Federal Register 2010, 2011, 2012, 2013, 2014

2012-03-30

...; Submission for OMB Review; Progress Payments (SF-1443) AGENCY: Department of Defense (DOD), General Services... DEPARTMENT OF DEFENSE GENERAL SERVICES ADMINISTRATION NATIONAL AERONAUTICS AND SPACE... requirement concerning progress payments. A notice was published in [[Page 19288

The Effects of Introducing Mixed Payment Systems for Physicians: Experimental Evidence.

PubMed

Brosig-Koch, Jeannette; Hennig-Schmidt, Heike; Kairies-Schwarz, Nadja; Wiesen, Daniel

2017-02-01

Mixed payment systems have become a prominent alternative to paying physicians through fee-for-service and capitation. While theory shows mixed payment systems to be superior, causal effects on physicians' behavior when introducing mixed systems are not well understood empirically. We systematically analyze the influence of fee-for-service, capitation, and mixed payment systems on physicians' service provision. In a controlled laboratory setting, we implement an exogenous variation of the payment method. Medical and non-medical students in the role of physicians in the lab (N = 213) choose quantities of medical services affecting patients' health outside the lab. Behavioral data reveal significant overprovision of medical services under fee-for-service and significant underprovision under capitation, although less than predicted when assuming profit maximization. Introducing mixed payment systems significantly reduces deviations from patient-optimal treatment. Although medical students tend to be more patient regarding, our results hold for both medical and non-medical students. Responses to incentive systems can be explained by a behavioral model capturing individual altruism. In particular, we find support that altruism plays a role in service provision and can partially mitigate agency problems, but altruism is heterogeneous in the population. Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.

Progress and challenges of the rural cooperative medical scheme in China

PubMed Central

Xu, Ke

2014-01-01

Abstract Problem During China’s transition to a market economy in the 1980s and 1990s, the rural population faced substantial barriers to accessing health care and encountered heavier financial burdens than urban residents in paying for necessary health services. Approach In 2003, China started to implement a rural cooperative medical scheme (RCMS), mainly through government subsidies. The scheme operates at the county level and offers a modest benefit package. Local setting In spite of rapid economic growth since the early 1980s, income disparities in China have increased, particularly between rural and urban populations. In response, the government has put greater emphasis on social development, including health system development. Examples are the prioritization of improved access to health services and the reduction of the burden of payment for necessary services. Relevant changes After 10 years of implementation, the RCMS now provides coverage to the entire rural population and has substantially improved access to health care. Yet despite a drop in out-of-pocket payments as a proportion of total health expenditure, paying for necessary services continues to cause financial hardship for many rural residents. Lessons learnt In its first decade, the RCMS made progress through political mobilization, government subsidies, the readiness of the health-care delivery system, and the availability of a monitoring and evaluation system. Further improving the RCMS will require a focus on cost containment, quality improvement and making the scheme portable. PMID:24940019

47 CFR 54.523 - Payment for the non-discount portion of supported services.

Code of Federal Regulations, 2012 CFR

2012-10-01

...) COMMON CARRIER SERVICES (CONTINUED) UNIVERSAL SERVICE Universal Service Support for Schools and Libraries § 54.523 Payment for the non-discount portion of supported services. An eligible school, library, or... discounts. An eligible school, library, or consortium may not receive rebates for services or products...

47 CFR 54.523 - Payment for the non-discount portion of supported services.

Code of Federal Regulations, 2011 CFR

2011-10-01

...) COMMON CARRIER SERVICES (CONTINUED) UNIVERSAL SERVICE Universal Service Support for Schools and Libraries § 54.523 Payment for the non-discount portion of supported services. An eligible school, library, or... discounts. An eligible school, library, or consortium may not receive rebates for services or products...

47 CFR 54.523 - Payment for the non-discount portion of supported services.

Code of Federal Regulations, 2010 CFR

2010-10-01

... discounts. An eligible school, library, or consortium may not receive rebates for services or products...) COMMON CARRIER SERVICES (CONTINUED) UNIVERSAL SERVICE Universal Service Support for Schools and Libraries § 54.523 Payment for the non-discount portion of supported services. An eligible school, library, or...

An inter-country comparison of unofficial payments: results of a health sector social audit in the Baltic States

PubMed Central

Cockcroft, Anne; Andersson, Neil; Paredes-Solís, Sergio; Caldwell, Dawn; Mitchell, Steve; Milne, Deborah; Merhi, Serge; Roche, Melissa; Konceviciute, Elena; Ledogar, Robert J

2008-01-01

Background Cross-country comparisons of unofficial payments in the health sector are sparse. In 2002 we conducted a social audit of the health sector of the three Baltic States. Methods Some 10,320 household interviews from a stratified, last-stage-random, sample of 30 clusters per country, together with institutional reviews, produced preliminary results. Separate focus groups of service users, nurses and doctors interpreted these findings. Stakeholder workshops in each country discussed the survey and focus group results. Results Nearly one half of the respondents did not consider unofficial payments to health workers to be corruption, yet one half (Estonia 43%, Latvia 45%, Lithuania 64%) thought the level of corruption in government health services was high. Very few (Estonia 1%, Latvia 3%, Lithuania 8%) admitted to making unofficial payments in their last contact with the services. Around 14% of household members across the three countries gave gifts in their last contact with government services. Conclusion This social audit allowed comparison of perceptions, attitudes and experience regarding unofficial payments in the health services of the three Baltic States. Estonia showed least corruption. Latvia was in the middle. Lithuania evidenced the most unofficial payments, the greatest mistrust towards the system. These findings can serve as a baseline for interventions, and to compare each country's approach to health service reform in relation to unofficial payments. PMID:18208604

Radiation oncology services in the modern era: evolving patterns of usage and payments in the office setting for medicare patients from 2000 to 2010.

PubMed

Shen, Xinglei; Showalter, Timothy N; Mishra, Mark V; Barth, Sanford; Rao, Vijay; Levin, David; Parker, Laurence

2014-07-01

We evaluated long-term changes in the volume and payments for radiation oncology services in the intensity-modulated radiation therapy (IMRT) era from 2000 to 2010 using a database of Medicare claims. We used the Medicare Physician/Supplier Procedure Summary Master File (PSPSMF) for each year from 2000 to 2010 to tabulate the volume and payments for radiation oncology services. This database provides a summary of each billing code submitted to Medicare part B. We identified all codes used in radiation oncology services and categorized billing codes by treatment modality and place of service. We focused our analysis on office-based practices. Total office-based patient volume increased 8.2% from 2000 to 2010, whereas total payments increased 217%. Increase in overall payments increased dramatically from 2000 to 2007, but subsequently plateaued from 2008 to 2010. Increases in complexity of care, and image guidance in particular, have also resulted in higher payments. The cost of radiation oncology services increased from 2000 to 2010, mostly due to IMRT, but also with significant contribution from increased overall complexity of care. A cost adjustment occurred after 2007, limiting further growth of payments. Future health policy studies should explore the potential for further cost containment, including differences in use between freestanding and hospital outpatient facilities. Copyright © 2014 by American Society of Clinical Oncology.

An inter-country comparison of unofficial payments: results of a health sector social audit in the Baltic States.

PubMed

Cockcroft, Anne; Andersson, Neil; Paredes-Solís, Sergio; Caldwell, Dawn; Mitchell, Steve; Milne, Deborah; Merhi, Serge; Roche, Melissa; Konceviciute, Elena; Ledogar, Robert J

2008-01-21

Cross-country comparisons of unofficial payments in the health sector are sparse. In 2002 we conducted a social audit of the health sector of the three Baltic States. Some 10,320 household interviews from a stratified, last-stage-random, sample of 30 clusters per country, together with institutional reviews, produced preliminary results. Separate focus groups of service users, nurses and doctors interpreted these findings. Stakeholder workshops in each country discussed the survey and focus group results. Nearly one half of the respondents did not consider unofficial payments to health workers to be corruption, yet one half (Estonia 43%, Latvia 45%, Lithuania 64%) thought the level of corruption in government health services was high. Very few (Estonia 1%, Latvia 3%, Lithuania 8%) admitted to making unofficial payments in their last contact with the services. Around 14% of household members across the three countries gave gifts in their last contact with government services. This social audit allowed comparison of perceptions, attitudes and experience regarding unofficial payments in the health services of the three Baltic States. Estonia showed least corruption. Latvia was in the middle. Lithuania evidenced the most unofficial payments, the greatest mistrust towards the system. These findings can serve as a baseline for interventions, and to compare each country's approach to health service reform in relation to unofficial payments.

Payment Reduction and Medicare Private Fee-for-Service Plans

PubMed Central

Frakt, Austin B.; Pizer, Steven D.; Feldman, Roger

2009-01-01

Medicare private fee-for-service (PFFS) plans are paid like other Medicare Advantage (MA) plans but are exempt from many MA requirements. Recently, Congress set average payments well above the costs of traditional fee-for-service (FFS) Medicare, inducing dramatic increases in PFFS plan enrollment. This has significant implications for Medicare's budget, provoking calls for policy change. We predict the effect of proposals to cut PFFS payments on PFFS plan participation and enrollment. We find that small reductions in payment rates would reduce PFFS participation and enrollment; if Congress reduces payments to traditional FFS levels it would cause the vast majority (85 percent) of PFFS plans to exit the market. PMID:19544932

42 CFR 7.5 - Payment procedures.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 1 2010-10-01 2010-10-01 false Payment procedures. 7.5 Section 7.5 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL PROVISIONS DISTRIBUTION OF REFERENCE BIOLOGICAL STANDARDS AND BIOLOGICAL PREPARATIONS § 7.5 Payment procedures. The requester may...

42 CFR 403.310 - Reduction in payments.

Code of Federal Regulations, 2010 CFR

2010-10-01

... Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL PROVISIONS SPECIAL PROGRAMS AND PROJECTS Recognition of State Reimbursement Control Systems § 403.310... amount by which the Medicare payments under the system exceed the amount of Medicare payments to such...

48 CFR 342.7003-2 - Procedures to be followed when withholding payments.

Code of Federal Regulations, 2013 CFR

2013-10-01

... when withholding payments. 342.7003-2 Section 342.7003-2 Federal Acquisition Regulations System HEALTH AND HUMAN SERVICES CONTRACT MANAGEMENT CONTRACT ADMINISTRATION Contract Monitoring 342.7003-2... deliver required work or services. When making the determination to withhold contract payments in...

48 CFR 342.7003-2 - Procedures to be followed when withholding payments.

Code of Federal Regulations, 2012 CFR

2012-10-01

... when withholding payments. 342.7003-2 Section 342.7003-2 Federal Acquisition Regulations System HEALTH AND HUMAN SERVICES CONTRACT MANAGEMENT CONTRACT ADMINISTRATION Contract Monitoring 342.7003-2... deliver required work or services. When making the determination to withhold contract payments in...

48 CFR 342.7003-2 - Procedures to be followed when withholding payments.

Code of Federal Regulations, 2011 CFR

2011-10-01

... when withholding payments. 342.7003-2 Section 342.7003-2 Federal Acquisition Regulations System HEALTH AND HUMAN SERVICES CONTRACT MANAGEMENT CONTRACT ADMINISTRATION Contract Monitoring 342.7003-2... deliver required work or services. When making the determination to withhold contract payments in...

48 CFR 342.7003-2 - Procedures to be followed when withholding payments.

Code of Federal Regulations, 2014 CFR

2014-10-01

... when withholding payments. 342.7003-2 Section 342.7003-2 Federal Acquisition Regulations System HEALTH AND HUMAN SERVICES CONTRACT MANAGEMENT CONTRACT ADMINISTRATION Contract Monitoring 342.7003-2... deliver required work or services. When making the determination to withhold contract payments in...

20 CFR 411.720 - If an alternate participant chooses not to become an EN, can it continue to function under the...

Code of Federal Regulations, 2010 CFR

2010-04-01

... become an EN, can it continue to function under the programs for payments for VR services? 411.720... continue to function under the programs for payments for VR services? Once the Ticket to Work program has been implemented in a State, the alternate participant programs for payments for VR services begin to...

20 CFR 411.720 - If an alternate participant chooses not to become an EN, can it continue to function under the...

Code of Federal Regulations, 2011 CFR

2011-04-01

... become an EN, can it continue to function under the programs for payments for VR services? 411.720... continue to function under the programs for payments for VR services? Once the Ticket to Work program has been implemented in a State, the alternate participant programs for payments for VR services begin to...

20 CFR 416.2212 - Payment for VR services in a case where an individual continues to receive disability or...

Code of Federal Regulations, 2011 CFR

2011-04-01

... 20 Employees' Benefits 2 2011-04-01 2011-04-01 false Payment for VR services in a case where an individual continues to receive disability or blindness benefits based on participation in an approved VR... Provisions § 416.2212 Payment for VR services in a case where an individual continues to receive disability...

20 CFR 416.2212 - Payment for VR services in a case where an individual continues to receive disability or...

Code of Federal Regulations, 2010 CFR

2010-04-01

... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false Payment for VR services in a case where an individual continues to receive disability or blindness benefits based on participation in an approved VR... Provisions § 416.2212 Payment for VR services in a case where an individual continues to receive disability...

Aging: GAO Activities in Fiscal Year 1985.

DTIC Science & Technology

1985-12-01

Fee Schedule for Laboratory Services * Survey of HCFA’s Ongoing Efforts to Assure the Appropriateness of Medicare DRG Payment Rates * Review of New...unnecessary expenditures for prosthetic lenses and related Reduce Medicare professional services used after the removal of cataracts and inequitable Payments...Requirements for Evaluating the Impacts of Medicare Pro- spective Payment on Post-Hospital Long-Term-Care Services : Prelimi- nary Report (GAO/PEMD-85

20 CFR 411.720 - If an alternate participant chooses not to become an EN, can it continue to function under the...

Code of Federal Regulations, 2012 CFR

2012-04-01

... become an EN, can it continue to function under the programs for payments for VR services? 411.720... continue to function under the programs for payments for VR services? Once the Ticket to Work program has been implemented in a State, the alternate participant programs for payments for VR services begin to...

20 CFR 411.720 - If an alternate participant chooses not to become an EN, can it continue to function under the...

Code of Federal Regulations, 2013 CFR

2013-04-01

... become an EN, can it continue to function under the programs for payments for VR services? 411.720... continue to function under the programs for payments for VR services? Once the Ticket to Work program has been implemented in a State, the alternate participant programs for payments for VR services begin to...

20 CFR 416.2212 - Payment for VR services in a case where an individual continues to receive disability or...

Code of Federal Regulations, 2014 CFR

2014-04-01

... 20 Employees' Benefits 2 2014-04-01 2014-04-01 false Payment for VR services in a case where an individual continues to receive disability or blindness benefits based on participation in an approved VR... Provisions § 416.2212 Payment for VR services in a case where an individual continues to receive disability...

20 CFR 411.720 - If an alternate participant chooses not to become an EN, can it continue to function under the...

Code of Federal Regulations, 2014 CFR

2014-04-01

... become an EN, can it continue to function under the programs for payments for VR services? 411.720... continue to function under the programs for payments for VR services? Once the Ticket to Work program has been implemented in a State, the alternate participant programs for payments for VR services begin to...

20 CFR 416.2212 - Payment for VR services in a case where an individual continues to receive disability or...

Code of Federal Regulations, 2013 CFR

2013-04-01

... 20 Employees' Benefits 2 2013-04-01 2013-04-01 false Payment for VR services in a case where an individual continues to receive disability or blindness benefits based on participation in an approved VR... Provisions § 416.2212 Payment for VR services in a case where an individual continues to receive disability...

20 CFR 416.2212 - Payment for VR services in a case where an individual continues to receive disability or...

Code of Federal Regulations, 2012 CFR

2012-04-01

... 20 Employees' Benefits 2 2012-04-01 2012-04-01 false Payment for VR services in a case where an individual continues to receive disability or blindness benefits based on participation in an approved VR... Provisions § 416.2212 Payment for VR services in a case where an individual continues to receive disability...

42 CFR 419.22 - Hospital services excluded from payment under the hospital outpatient prospective payment system.

Code of Federal Regulations, 2013 CFR

2013-10-01

... meet the requirements of § 415.102(a) of this chapter for payment on a fee schedule basis. (b) Nurse practitioner and clinical nurse specialist services, as defined in section 1861(s)(2)(K)(ii) of the Act. (c) Physician assistant services, as defined in section 1861(s)(2)(K)(i) of the Act. (d) Certified nurse-midwife...

Shifting Away From Fee-For-Service: Alternative Approaches to Payment in Gastroenterology.

PubMed

Patel, Kavita; Presser, Elise; George, Meaghan; McClellan, Mark

2016-04-01

Fee-for-service payments encourage high-volume services rather than high-quality care. Alternative payment models (APMs) aim to realign financing to support high-value services. The 2 main components of gastroenterologic care, procedures and chronic care management, call for a range of APMs. The first step for gastroenterologists is to identify the most important conditions and opportunities to improve care and reduce waste that do not require financial support. We describe examples of delivery reforms and emerging APMs to accomplish these care improvements. A bundled payment for an episode of care, in which a provider is given a lump sum payment to cover the cost of services provided during the defined episode, can support better care for a discrete procedure such as a colonoscopy. Improved management of chronic conditions can be supported through a per-member, per-month (PMPM) payment to offer extended services and care coordination. For complex chronic conditions such as inflammatory bowel disease, in which the gastroenterologist is the principal care coordinator, the PMPM payment could be given to a gastroenterology medical home. For conditions in which the gastroenterologist acts primarily as a consultant for primary care, such as noncomplex gastroesophageal reflux or hepatitis C, a PMPM payment can support effective care coordination in a medical neighborhood delivery model. Each APM can be supplemented with a shared savings component. Gastroenterologists must engage with and be early leaders of these redesign discussions to be prepared for a time when APMs may be more prevalent and no longer voluntary. Copyright © 2016 AGA Institute. Published by Elsevier Inc. All rights reserved.

42 CFR 418.304 - Payment for physician and nurse practitioner services.

Code of Federal Regulations, 2010 CFR

2010-10-01

... policies by the physician member of the interdisciplinary group. (b) For services not described in... for hospice pre-election evaluation and counseling services. The intermediary makes payment to the...

Rehabilitation of compensable workplace injuries: effective payment models for quality vocational rehabilitation outcomes in a changing social landscape.

PubMed

Matthews, Lynda R; Hanley, Francine; Lewis, Virginia; Howe, Caroline

2015-01-01

With social and economic costs of workplace injury on the increase, efficient payment models that deliver quality rehabilitation outcomes are of increasing interest. This paper provides a perspective on the issue informed by both refereed literature and published research material not available commercially (gray literature). A review of payment models, workers' compensation and compensable injury identified relevant peer-reviewed and gray literature that informed our discussion. Fee-for-service and performance-based payment models dominate the health and rehabilitation literature, each described as having benefits and challenges to achieving quality outcomes for consumers. There appears to be a movement toward performance-based payments in compensable workplace injury settings as they are perceived to promote time-efficient services and support innovation in rehabilitation practice. However, it appears that the challenges that arise for workplace-based rehabilitation providers and professionals when working under the various payment models, such as staff retention and quality of client-practitioner relationship, are absent from the literature and this could lead to flawed policy decisions. Robust evidence of the benefits and costs associated with different payment models - from the perspectives of clients/consumers, funders and service providers - is needed to inform best practice in rehabilitation of compensable workplace injuries. Available but limited evidence suggests that payment models providing financial incentives for stakeholder-agreed vocational rehabilitation outcomes tend to improve service effectiveness in workers' compensation settings, although there is little evidence of service quality or client satisfaction. Working in a system that identifies payments for stakeholder-agreed outcomes may be more satisfying for rehabilitation practitioners in workers' compensation settings by allowing more clinical autonomy and innovative practice. Researchers need to work closely with the compensation and rehabilitation sector as well as governments to establish robust evidence of the benefits and costs of payment models, from the perspectives of clients/consumers, funders, service providers and rehabilitation professionals.

42 CFR 447.207 - Retention of payments.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 4 2010-10-01 2010-10-01 false Retention of payments. 447.207 Section 447.207 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES... computable payment to ensure that the State's claimed expenditure, which serves as the basis for Federal...

42 CFR 413.172 - Principles of prospective payment.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 2 2010-10-01 2010-10-01 false Principles of prospective payment. 413.172 Section... SERVICES MEDICARE PROGRAM PRINCIPLES OF REASONABLE COST REIMBURSEMENT; PAYMENT FOR END-STAGE RENAL DISEASE...-Stage Renal Disease (ESRD) Services and Organ Procurement Costs § 413.172 Principles of prospective...

42 CFR 412.108 - Special treatment: Medicare-dependent, small rural hospitals.

Code of Federal Regulations, 2010 CFR

2010-10-01

... HEALTH AND HUMAN SERVICES MEDICARE PROGRAM PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Special Treatment of Certain Facilities Under the Prospective Payment System for Inpatient Operating Costs... including days and discharges from units excluded from the prospective payment system under §§ 412.25...

42 CFR § 512.450 - Beneficiary choice and beneficiary notification.

Code of Federal Regulations, 2010 CFR

2017-10-01

... HEALTH AND HUMAN SERVICES (CONTINUED) HEALTH CARE INFRASTRUCTURE AND MODEL PROGRAMS EPISODE PAYMENT MODEL... providers or suppliers, nor may the EPM participant accept such payments. (b) Required beneficiary... beneficiary will be responsible for payment for the services furnished by the SNF during that stay, except...

42 CFR § 512.210 - Included and excluded services.

Code of Federal Regulations, 2010 CFR

2017-10-01

... SERVICES (CONTINUED) HEALTH CARE INFRASTRUCTURE AND MODEL PROGRAMS EPISODE PAYMENT MODEL Scope of Episodes...) Certain PBPM payments under models tested under section 1115A of the Act that CMS determines to be... PBPM model payments funded from the Innovation Center appropriation. (c) Updating the exclusion lists...

38 CFR 17.1002 - Substantive conditions for payment or reimbursement.

Code of Federal Regulations, 2013 CFR

2013-07-01

... DEPARTMENT OF VETERANS AFFAIRS MEDICAL Payment Or Reimbursement for Emergency Services for Nonservice.... Payment or reimbursement under 38 U.S.C. 1725 for emergency treatment (including medical services... medication related to and necessary for the treatment of the emergency condition that is provided directly to...

38 CFR 17.1002 - Substantive conditions for payment or reimbursement.

Code of Federal Regulations, 2012 CFR

2012-07-01

... DEPARTMENT OF VETERANS AFFAIRS MEDICAL Payment Or Reimbursement for Emergency Services for Nonservice.... Payment or reimbursement under 38 U.S.C. 1725 for emergency treatment (including medical services... medication related to and necessary for the treatment of the emergency condition that is provided directly to...

38 CFR 17.1002 - Substantive conditions for payment or reimbursement.

Code of Federal Regulations, 2014 CFR

2014-07-01

... DEPARTMENT OF VETERANS AFFAIRS MEDICAL Payment Or Reimbursement for Emergency Services for Nonservice.... Payment or reimbursement under 38 U.S.C. 1725 for emergency treatment (including medical services... medication related to and necessary for the treatment of the emergency condition that is provided directly to...

Empirical models of demand for out-patient physician services and their relevance to the assessment of patient payment policies: a critical review of the literature.

PubMed

Skriabikova, Olga; Pavlova, Milena; Groot, Wim

2010-06-01

This paper reviews the existing empirical micro-level models of demand for out-patient physician services where the size of patient payment is included either directly as an independent variable (when a flat-rate co-payment fee) or indirectly as a level of deductibles and/or co-insurance defined by the insurance coverage. The paper also discusses the relevance of these models for the assessment of patient payment policies. For this purpose, a systematic literature review is carried out. In total, 46 relevant publications were identified. These publications are classified into categories based on their general approach to demand modeling, specifications of data collection, data analysis, and main empirical findings. The analysis indicates a rising research interest in the empirical micro-level models of demand for out-patient physician services that incorporate the size of patient payment. Overall, the size of patient payments, consumer socio-economic and demographic features, and quality of services provided emerge as important determinants of demand for out-patient physician services. However, there is a great variety in the modeling approaches and inconsistencies in the findings regarding the impact of price on demand for out-patient physician services. Hitherto, the empirical research fails to offer policy-makers a clear strategy on how to develop a country-specific model of demand for out-patient physician services suitable for the assessment of patient payment policies in their countries. In particular, theoretically important factors, such as provider behavior, consumer attitudes, experience and culture, and informal patient payments, are not considered. Although we recognize that it is difficult to measure these factors and to incorporate them in the demand models, it is apparent that there is a gap in research for the construction of effective patient payment schemes.

Empirical Models of Demand for Out-Patient Physician Services and Their Relevance to the Assessment of Patient Payment Policies: A Critical Review of the Literature

PubMed Central

Skriabikova, Olga; Pavlova, Milena; Groot, Wim

2010-01-01

This paper reviews the existing empirical micro-level models of demand for out-patient physician services where the size of patient payment is included either directly as an independent variable (when a flat-rate co-payment fee) or indirectly as a level of deductibles and/or co-insurance defined by the insurance coverage. The paper also discusses the relevance of these models for the assessment of patient payment policies. For this purpose, a systematic literature review is carried out. In total, 46 relevant publications were identified. These publications are classified into categories based on their general approach to demand modeling, specifications of data collection, data analysis, and main empirical findings. The analysis indicates a rising research interest in the empirical micro-level models of demand for out-patient physician services that incorporate the size of patient payment. Overall, the size of patient payments, consumer socio-economic and demographic features, and quality of services provided emerge as important determinants of demand for out-patient physician services. However, there is a great variety in the modeling approaches and inconsistencies in the findings regarding the impact of price on demand for out-patient physician services. Hitherto, the empirical research fails to offer policy-makers a clear strategy on how to develop a country-specific model of demand for out-patient physician services suitable for the assessment of patient payment policies in their countries. In particular, theoretically important factors, such as provider behavior, consumer attitudes, experience and culture, and informal patient payments, are not considered. Although we recognize that it is difficult to measure these factors and to incorporate them in the demand models, it is apparent that there is a gap in research for the construction of effective patient payment schemes. PMID:20644697

42 CFR 412.120 - Reductions to total payments.

Code of Federal Regulations, 2010 CFR

2010-10-01

... MEDICARE PROGRAM PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Payments to Hospitals Under the Prospective Payment Systems § 412.120 Reductions to total payments. (a) Deductible and coinsurance... 42 Public Health 2 2010-10-01 2010-10-01 false Reductions to total payments. 412.120 Section 412...

Web-Based Honorarium Confirmation System Prototype

NASA Astrophysics Data System (ADS)

Wisswani, N. W.; Catur Bawa, I. G. N. B.

2018-01-01

Improving services in academic environment can be applied by regulating salary payment process for all employees. As a form of control to maintain financial transparency, employees should have information concerning salary payment process. Currently, notification process of committee honorarium will be accepted by the employees in a manual manner. The salary will be received by the employee bank account and to know its details, they should go to the accounting unit to find out further information. Though there are some employees entering the accounting unit, they still find difficulty to obtain information about detailed honor information that they received in their accounts. This can be caused by many data collected and to be managed. Based on this issue, this research will design a prototype of web-based system for accounting unit system in order to provide detailed financial transaction confirmation to employee bank accounts that have been informed through mobile banking system. This prototype will be developed with Waterfall method through testing on final users after it is developed through PHP program with MySQL as DBMS

Funding long-term care: applications of the trade-off principle in both public and private sectors.

PubMed

Chen, Yung-Ping

2003-02-01

The uncertain need for long-term care services is a risk best protected by insurance. However, the current funding relies heavily on personal payment and public welfare, and only lightly on social and private insurances. This method, akin to sitting on a two-legged stool, is unlikely to be sustainable. To incorporate insurance as a key component of funding and to mobilize public and private resources more effectively, we propose a three-legged-stool funding model under which social insurance would provide a basic protection, to be supplemented by private insurance and personal payment. When these sources do not provide sufficient protection for some individuals, Medicaid as public welfare would serve as a safety net. This article (a) discusses how to implement this funding model by using the trade-off principle in both the public and private sectors when resources for long-term care are scarce, and (b) analyzes several objections to this model from cognitive psychology/behavioral economics

42 CFR 415.172 - Physician fee schedule payment for services of teaching physicians.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 3 2010-10-01 2010-10-01 false Physician fee schedule payment for services of teaching physicians. 415.172 Section 415.172 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM SERVICES FURNISHED BY PHYSICIANS IN...

47 CFR 1.1102 - Schedule of charges for applications and other filings in the wireless telecommunications services.

Code of Federal Regulations, 2012 CFR

2012-10-01

... filings in the wireless telecommunications services. 1.1102 Section 1.1102 Telecommunication FEDERAL... wireless telecommunications services. Those services designated with an asterisk in the payment type code... manual filings and/or payment for these services to the: Federal Communications Commission, Wireless...

47 CFR 1.1102 - Schedule of charges for applications and other filings in the wireless telecommunications services.

Code of Federal Regulations, 2013 CFR

2013-10-01

... filings in the wireless telecommunications services. 1.1102 Section 1.1102 Telecommunication FEDERAL... wireless telecommunications services. Those services designated with an asterisk in the payment type code... manual filings and/or payment for these services to the: Federal Communications Commission, Wireless...

42 CFR 414.914 - Terms of contract.

Code of Federal Regulations, 2010 CFR

2010-10-01

... disabled, the hearing impaired, and Spanish-speaking inquirers in all customer service operations. (9) Meet... Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM PAYMENT FOR PART B MEDICAL AND OTHER HEALTH SERVICES Payment for Drugs and Biologicals...

42 CFR 411.46 - Lump-sum payments.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 2 2010-10-01 2010-10-01 false Lump-sum payments. 411.46 Section 411.46 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM... Covered Under Workers' Compensation § 411.46 Lump-sum payments. (a) Lump-sum commutation of future...

42 CFR 419.64 - Transitional pass-through payments: Drugs and biologicals.

Code of Federal Regulations, 2010 CFR

2010-10-01

... biologicals. 419.64 Section 419.64 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF... biologicals. (a) Eligibility for pass-through payment. CMS makes a transitional pass-through payment for the following drugs and biologicals that are furnished as part of an outpatient hospital service: (1) Orphan...

42 CFR 419.64 - Transitional pass-through payments: Drugs and biologicals.

Code of Federal Regulations, 2011 CFR

2011-10-01

... biologicals. 419.64 Section 419.64 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF... biologicals. (a) Eligibility for pass-through payment. CMS makes a transitional pass-through payment for the following drugs and biologicals that are furnished as part of an outpatient hospital service: (1) Orphan...

31 CFR 203.11 - Same-day reporting and payment mechanisms.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 31 Money and Finance: Treasury 2 2010-07-01 2010-07-01 false Same-day reporting and payment mechanisms. 203.11 Section 203.11 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) FISCAL SERVICE, DEPARTMENT OF THE TREASURY FINANCIAL MANAGEMENT SERVICE PAYMENT OF FEDERAL TAXES...

42 CFR 405.520 - Payment for a physician assistant's, nurse practitioner's, and clinical nurse specialists...

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 2 2010-10-01 2010-10-01 false Payment for a physician assistant's, nurse practitioner's, and clinical nurse specialists' services and services furnished incident to their professional... for Determining Reasonable Charges § 405.520 Payment for a physician assistant's, nurse practitioner's...

42 CFR 422.308 - Adjustments to capitation rates, benchmarks, bids, and payments.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 3 2011-10-01 2011-10-01 false Adjustments to capitation rates, benchmarks, bids, and payments. 422.308 Section 422.308 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM MEDICARE ADVANTAGE PROGRAM Payments to...

42 CFR 405.352 - Adjustment of title XVIII incorrect payments.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 2 2011-10-01 2011-10-01 false Adjustment of title XVIII incorrect payments. 405.352 Section 405.352 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM FEDERAL HEALTH INSURANCE FOR THE AGED AND DISABLED Suspension of Payment...

42 CFR 405.372 - Proceeding for suspension of payment.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 2 2011-10-01 2011-10-01 false Proceeding for suspension of payment. 405.372 Section 405.372 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM FEDERAL HEALTH INSURANCE FOR THE AGED AND DISABLED Suspension of Payment...

42 CFR 405.352 - Adjustment of title XVIII incorrect payments.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 2 2010-10-01 2010-10-01 false Adjustment of title XVIII incorrect payments. 405.352 Section 405.352 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM FEDERAL HEALTH INSURANCE FOR THE AGED AND DISABLED Suspension of Payment...

42 CFR 405.372 - Proceeding for suspension of payment.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 2 2010-10-01 2010-10-01 false Proceeding for suspension of payment. 405.372 Section 405.372 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM FEDERAL HEALTH INSURANCE FOR THE AGED AND DISABLED Suspension of Payment...

42 CFR § 512.720 - Appeals process for FFS-CR participants.

Code of Federal Regulations, 2010 CFR

2017-10-01

... SERVICES (CONTINUED) HEALTH CARE INFRASTRUCTURE AND MODEL PROGRAMS EPISODE PAYMENT MODEL CR Incentive Payment Model for EPM and Medicare Fee-for-Service Participants Provisions for Ffs-Cr Participants § 512... participant termination from the CR incentive payment model. If an FFS-CR participant receives notification...

42 CFR § 414.1445 - Identification of other payer advanced APMs.

Code of Federal Regulations, 2010 CFR

2017-10-01

... AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM (CONTINUED) PAYMENT FOR PART B MEDICAL AND OTHER HEALTH SERVICES Merit-Based Incentive Payment System and Alternative Payment Model Incentive § 414.1445... determination prior to the QP Performance Period to identify Medicaid Medical Home Models and Medicaid APMs. (b...

42 CFR § 512.735 - Enforcement authority for FFS-CR participants.

Code of Federal Regulations, 2010 CFR

2017-10-01

... HEALTH AND HUMAN SERVICES (CONTINUED) HEALTH CARE INFRASTRUCTURE AND MODEL PROGRAMS EPISODE PAYMENT MODEL CR Incentive Payment Model for EPM and Medicare Fee-for-Service Participants Provisions for Ffs-Cr... limited or restricted by the provisions of the CR incentive payment model, including the authority to...

42 CFR § 512.730 - Compliance enforcement for FFS-CR participants.

Code of Federal Regulations, 2010 CFR

2017-10-01

... HEALTH AND HUMAN SERVICES (CONTINUED) HEALTH CARE INFRASTRUCTURE AND MODEL PROGRAMS EPISODE PAYMENT MODEL CR Incentive Payment Model for EPM and Medicare Fee-for-Service Participants Provisions for Ffs-Cr... through monitoring by HHS (including CMS and OIG) of the CR incentive payment model, including but not...

42 CFR 412.8 - Publication of schedules for determining prospective payment rates.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 2 2010-10-01 2010-10-01 false Publication of schedules for determining prospective payment rates. 412.8 Section 412.8 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL...

42 CFR 455.510 - Payments to RACs.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 4 2011-10-01 2011-10-01 false Payments to RACs. 455.510 Section 455.510 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED....510 Payments to RACs. (a) General. Fees paid to RACs must be made only from amounts recovered. (b...

31 CFR 203.8 - Application of part and procedural instructions.

Code of Federal Regulations, 2013 CFR

2013-07-01

... binding on financial institutions that process Federal tax payments or maintain a TT&L account, TIP main... (Continued) FISCAL SERVICE, DEPARTMENT OF THE TREASURY FINANCIAL MANAGEMENT SERVICE PAYMENT OF FEDERAL TAXES... originating Federal tax payments, the financial institution agrees to be bound by this part and by procedural...

31 CFR 203.8 - Application of part and procedural instructions.

Code of Federal Regulations, 2012 CFR

2012-07-01

... binding on financial institutions that process Federal tax payments or maintain a TT&L account, TIP main... (Continued) FISCAL SERVICE, DEPARTMENT OF THE TREASURY FINANCIAL MANAGEMENT SERVICE PAYMENT OF FEDERAL TAXES... originating Federal tax payments, the financial institution agrees to be bound by this part and by procedural...

31 CFR 203.8 - Application of part and procedural instructions.

Code of Federal Regulations, 2011 CFR

2011-07-01

... binding on financial institutions that process Federal tax payments or maintain a TT&L account, TIP main... (Continued) FISCAL SERVICE, DEPARTMENT OF THE TREASURY FINANCIAL MANAGEMENT SERVICE PAYMENT OF FEDERAL TAXES... originating Federal tax payments, the financial institution agrees to be bound by this part and by procedural...

7 CFR 1005.82 - Payments from the transportation credit balancing fund.

Code of Federal Regulations, 2011 CFR

2011-01-01

...) AGRICULTURAL MARKETING SERVICE (Marketing Agreements and Orders; Milk), DEPARTMENT OF AGRICULTURE MILK IN THE APPALACHIAN MARKETING AREA Order Regulating Handling Marketwide Service Payments § 1005.82 Payments from the... Federal order as described in paragraph (c)(1) of this section or that received, and reported pursuant to...

7 CFR 1007.82 - Payments from the transportation credit balancing fund.

Code of Federal Regulations, 2011 CFR

2011-01-01

...) AGRICULTURAL MARKETING SERVICE (Marketing Agreements and Orders; Milk), DEPARTMENT OF AGRICULTURE MILK IN THE SOUTHEAST MARKETING AREA Order Regulating Handling Marketwide Service Payments § 1007.82 Payments from the... Federal order as described in paragraph (c)(1) of this section or that received, and reported pursuant to...

42 CFR 447.202 - Audits.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 4 2010-10-01 2010-10-01 false Audits. 447.202 Section 447.202 Public Health... ASSISTANCE PROGRAMS PAYMENTS FOR SERVICES Payment Methods: General Provisions § 447.202 Audits. The Medicaid agency must assure appropriate audit of records if payment is based on costs of services or on a fee plus...

50 CFR 260.69 - Payment fees and charges.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 50 Wildlife and Fisheries 7 2010-10-01 2010-10-01 false Payment fees and charges. 260.69 Section... Fishery Products for Human Consumption Fees and Charges § 260.69 Payment fees and charges. Fees and... services rendered. All fees and charges for any inspection service, performed pursuant to the regulations...

42 CFR 61.11 - Payments: Tuition and other expenses.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 1 2011-10-01 2011-10-01 false Payments: Tuition and other expenses. 61.11 Section 61.11 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES FELLOWSHIPS, INTERNSHIPS, TRAINING FELLOWSHIPS Regular Fellowships § 61.11 Payments: Tuition and other expenses. (a...

42 CFR 61.11 - Payments: Tuition and other expenses.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 1 2012-10-01 2012-10-01 false Payments: Tuition and other expenses. 61.11 Section 61.11 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES FELLOWSHIPS, INTERNSHIPS, TRAINING FELLOWSHIPS Regular Fellowships § 61.11 Payments: Tuition and other expenses. (a...

42 CFR 61.11 - Payments: Tuition and other expenses.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 1 2014-10-01 2014-10-01 false Payments: Tuition and other expenses. 61.11 Section 61.11 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES FELLOWSHIPS, INTERNSHIPS, TRAINING FELLOWSHIPS Regular Fellowships § 61.11 Payments: Tuition and other expenses. (a...

42 CFR 61.11 - Payments: Tuition and other expenses.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 42 Public Health 1 2013-10-01 2013-10-01 false Payments: Tuition and other expenses. 61.11 Section 61.11 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES FELLOWSHIPS, INTERNSHIPS, TRAINING FELLOWSHIPS Regular Fellowships § 61.11 Payments: Tuition and other expenses. (a...

42 CFR 61.11 - Payments: Tuition and other expenses.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 1 2010-10-01 2010-10-01 false Payments: Tuition and other expenses. 61.11 Section 61.11 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES FELLOWSHIPS, INTERNSHIPS, TRAINING FELLOWSHIPS Regular Fellowships § 61.11 Payments: Tuition and other expenses. (a...

14 CFR 389.12 - Payment of fees and charges.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 14 Aeronautics and Space 4 2010-01-01 2010-01-01 false Payment of fees and charges. 389.12 Section 389.12 Aeronautics and Space OFFICE OF THE SECRETARY, DEPARTMENT OF TRANSPORTATION (AVIATION PROCEEDINGS) ORGANIZATION FEES AND CHARGES FOR SPECIAL SERVICES Fees for Special Services § 389.12 Payment of...

14 CFR 389.12 - Payment of fees and charges.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 14 Aeronautics and Space 4 2011-01-01 2011-01-01 false Payment of fees and charges. 389.12 Section 389.12 Aeronautics and Space OFFICE OF THE SECRETARY, DEPARTMENT OF TRANSPORTATION (AVIATION PROCEEDINGS) ORGANIZATION FEES AND CHARGES FOR SPECIAL SERVICES Fees for Special Services § 389.12 Payment of...

31 CFR 250.5 - Manner of payment.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 31 Money and Finance: Treasury 2 2010-07-01 2010-07-01 false Manner of payment. 250.5 Section 250.5 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) FISCAL SERVICE, DEPARTMENT OF THE TREASURY FINANCIAL MANAGEMENT SERVICE PAYMENT ON ACCOUNT OF AWARDS OF THE FOREIGN CLAIMS...

Medicare Program; End-Stage Renal Disease Prospective Payment System, Payment for Renal Dialysis Services Furnished to Individuals With Acute Kidney Injury, and End-Stage Renal Disease Quality Incentive Program. Final rule.

PubMed

2017-11-01

This rule updates and makes revisions to the end-stage renal disease (ESRD) prospective payment system (PPS) for calendar year (CY) 2018. It also updates the payment rate for renal dialysis services furnished by an ESRD facility to individuals with acute kidney injury (AKI). This rule also sets forth requirements for the ESRD Quality Incentive Program (QIP), including for payment years (PYs) 2019 through 2021.

42 CFR 413.345 - Publication of Federal prospective payment rates.

Code of Federal Regulations, 2013 CFR

2013-10-01

... RENAL DISEASE SERVICES; OPTIONAL PROSPECTIVELY DETERMINED PAYMENT RATES FOR SKILLED NURSING FACILITIES Prospective Payment for Skilled Nursing Facilities § 413.345 Publication of Federal prospective payment rates...

42 CFR 413.345 - Publication of Federal prospective payment rates.

Code of Federal Regulations, 2010 CFR

2010-10-01

... RENAL DISEASE SERVICES; OPTIONAL PROSPECTIVELY DETERMINED PAYMENT RATES FOR SKILLED NURSING FACILITIES Prospective Payment for Skilled Nursing Facilities § 413.345 Publication of Federal prospective payment rates...

42 CFR 412.604 - Conditions for payment under the prospective payment system for inpatient rehabilitation facilities.

Code of Federal Regulations, 2010 CFR

2010-10-01

... payment system for inpatient rehabilitation facilities. 412.604 Section 412.604 Public Health CENTERS FOR... SYSTEMS FOR INPATIENT HOSPITAL SERVICES Prospective Payment for Inpatient Rehabilitation Hospitals and Rehabilitation Units § 412.604 Conditions for payment under the prospective payment system for inpatient...

42 CFR 413.350 - Periodic interim payments for skilled nursing facilities receiving payment under the skilled...

Code of Federal Regulations, 2013 CFR

2013-10-01

... 42 Public Health 2 2013-10-01 2013-10-01 false Periodic interim payments for skilled nursing facilities receiving payment under the skilled nursing facility prospective payment system for Part A...-STAGE RENAL DISEASE SERVICES; OPTIONAL PROSPECTIVELY DETERMINED PAYMENT RATES FOR SKILLED NURSING...

42 CFR 413.350 - Periodic interim payments for skilled nursing facilities receiving payment under the skilled...

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 2 2012-10-01 2012-10-01 false Periodic interim payments for skilled nursing facilities receiving payment under the skilled nursing facility prospective payment system for Part A...-STAGE RENAL DISEASE SERVICES; OPTIONAL PROSPECTIVELY DETERMINED PAYMENT RATES FOR SKILLED NURSING...

42 CFR 413.350 - Periodic interim payments for skilled nursing facilities receiving payment under the skilled...

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 2 2010-10-01 2010-10-01 false Periodic interim payments for skilled nursing facilities receiving payment under the skilled nursing facility prospective payment system for Part A...-STAGE RENAL DISEASE SERVICES; OPTIONAL PROSPECTIVELY DETERMINED PAYMENT RATES FOR SKILLED NURSING...

42 CFR 413.350 - Periodic interim payments for skilled nursing facilities receiving payment under the skilled...

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 2 2011-10-01 2011-10-01 false Periodic interim payments for skilled nursing facilities receiving payment under the skilled nursing facility prospective payment system for Part A...-STAGE RENAL DISEASE SERVICES; OPTIONAL PROSPECTIVELY DETERMINED PAYMENT RATES FOR SKILLED NURSING...

42 CFR 413.350 - Periodic interim payments for skilled nursing facilities receiving payment under the skilled...

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 2 2014-10-01 2014-10-01 false Periodic interim payments for skilled nursing facilities receiving payment under the skilled nursing facility prospective payment system for Part A...-STAGE RENAL DISEASE SERVICES; OPTIONAL PROSPECTIVELY DETERMINED PAYMENT RATES FOR SKILLED NURSING...

7 CFR 4288.130 - Payment applications.

Code of Federal Regulations, 2012 CFR

2012-01-01

... RURAL UTILITIES SERVICE, DEPARTMENT OF AGRICULTURE PAYMENT PROGRAMS Advanced Biofuel Payment Program... process and procedures the Agency will use to make payments to eligible advanced biofuel producers. In order to receive payments under this Program, eligible advanced biofuel producers with valid contracts...

7 CFR 4288.130 - Payment applications.

Code of Federal Regulations, 2013 CFR

2013-01-01

... RURAL UTILITIES SERVICE, DEPARTMENT OF AGRICULTURE PAYMENT PROGRAMS Advanced Biofuel Payment Program... process and procedures the Agency will use to make payments to eligible advanced biofuel producers. In order to receive payments under this Program, eligible advanced biofuel producers with valid contracts...

7 CFR 4288.131 - Payment provisions.

Code of Federal Regulations, 2013 CFR

2013-01-01

... RURAL UTILITIES SERVICE, DEPARTMENT OF AGRICULTURE PAYMENT PROGRAMS Advanced Biofuel Payment Program General Provisions § 4288.131 Payment provisions. Payments to advanced biofuel producers for eligible advanced biofuel production will be determined in accordance with the provisions of this section. (a) Types...

7 CFR 4288.130 - Payment applications.

Code of Federal Regulations, 2014 CFR

2014-01-01

... RURAL UTILITIES SERVICE, DEPARTMENT OF AGRICULTURE PAYMENT PROGRAMS Advanced Biofuel Payment Program... identify the process and procedures the Agency will use to make payments to eligible advanced biofuel producers. In order to receive payments under this Program, eligible advanced biofuel producers with valid...

7 CFR 4288.131 - Payment provisions.

Code of Federal Regulations, 2012 CFR

2012-01-01

... RURAL UTILITIES SERVICE, DEPARTMENT OF AGRICULTURE PAYMENT PROGRAMS Advanced Biofuel Payment Program General Provisions § 4288.131 Payment provisions. Payments to advanced biofuel producers for eligible advanced biofuel production will be determined in accordance with the provisions of this section. (a) Types...

42 CFR 417.105 - Payment for supplemental health services.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 3 2014-10-01 2014-10-01 false Payment for supplemental health services. 417.105 Section 417.105 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM (CONTINUED) HEALTH MAINTENANCE ORGANIZATIONS, COMPETITIVE MEDICAL...

42 CFR 417.105 - Payment for supplemental health services.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 3 2012-10-01 2012-10-01 false Payment for supplemental health services. 417.105 Section 417.105 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM (CONTINUED) HEALTH MAINTENANCE ORGANIZATIONS, COMPETITIVE MEDICAL...

42 CFR 417.105 - Payment for supplemental health services.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 3 2010-10-01 2010-10-01 false Payment for supplemental health services. 417.105 Section 417.105 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM HEALTH MAINTENANCE ORGANIZATIONS, COMPETITIVE MEDICAL PLANS, AND...

32 CFR 299.4 - Responsibilities.

Code of Federal Regulations, 2010 CFR

2010-07-01

...) Compiling the annual FOIA report. (c) The Chief, Accounting and Financial Services (DF22) is responsible for... Financial Services, payment may be received directly in Accounting and Financial Services. Such payment may... initiated by Accounting and Financial Services; and (4) Issuing a prompt reimbursement of overpaid fees to...

No association between Centers for Medicare and Medicaid services payments and volume of Medicare beneficiaries or per-capita health care costs for each state.

PubMed

Harewood, Gavin C; Alsaffar, Omar

2015-03-01

The Centers for Medicare and Medicaid Services recently published data on Medicare payments to physicians for 2012. We investigated regional variations in payments to gastroenterologists and evaluated whether payments correlated with the number of Medicare patients in each state. We found that the mean payment per gastroenterologist in each state ranged from $35,293 in Minnesota to $175,028 in Mississippi. Adjusted per-physician payments ranged from $11 per patient in Hawaii to $62 per patient in Washington, DC. There was no correlation between the mean per-physician payment and the mean number of Medicare patients per physician (r = 0.09), there also was no correlation between the mean per-physician payment and the overall mean per-capita health care costs for each state (r = -0.22). There was a 5.6-fold difference between the states with the lowest and highest adjusted Medicare payments to gastroenterologists. Therefore, the Centers for Medicare and Medicaid Services payments do not appear to be associated with the volume of Medicare beneficiaries or overall per-capita health care costs for each state. Copyright © 2015 AGA Institute. Published by Elsevier Inc. All rights reserved.

The inability to pay for health services in Central and Eastern Europe: evidence from six countries

PubMed Central

Pavlova, Milena; Rechel, Bernd; Golinowska, Stanisława; Sowada, Christoph; Groot, Wim

2014-01-01

Background: Out-of-pocket payments for health services constitute a major financial burden for patients in Central and Eastern European (CEE) countries. Individuals who are unable to pay use different coping strategies (e.g. borrowing money or foregoing service utilization), which can have negative consequences on their health and social welfare. This article explores patients’ inability to pay for outpatient and hospital services in six CEE countries: Bulgaria, Hungary, Lithuania, Poland, Romania and Ukraine. Methods: The analysis is based on quantitative data collected in 2010 in nationally representative surveys. Two indicators of inability to pay were considered: the need to borrow money or sell assets and foregoing service utilization. Statistical analyses were applied to investigate associations between the indicators of inability to pay and individual characteristics. Results: Patient payments are most common in Bulgaria, Ukraine, Romania and Lithuania and often include informal payments. Romanian and, particularly, Ukrainian patients most often face difficulties to pay for health services (with approximately 40% of Ukrainian payers borrowing money or selling assets to cover hospital payments and approximately 60% of respondents who need care foregoing services). Inability to pay mainly affects those with poor health and low incomes. Conclusion: Widespread patient payments constitute a major financial barrier to health service use in CEE. There is a need to formalize them where they are informal and to take measures to protect vulnerable population groups, especially those with limited possibilities to deal with payment difficulties. PMID:24065370

Medicare program; Part B advance payments to suppliers furnishing items or services under Medicare Part B--HCFA. Final rule.

PubMed

1996-09-19

This rule establishes requirements and procedures for advance payments to suppliers of Medicare Part B services. An advance payment will be made only if the carrier is unable to process a claim timely; the supplier requests advance payment; we determine that payment of interest is insufficient to compensate the supplier for loss of the use of the funds; and, we expressly approve the advance payment in writing. These rules are necessary to address deficiencies noted by the General Accounting Office in its report analyzing current procedures for making advance payments. The intent of this rule is to ensure more efficient and effective administration of this aspect of the Medicare program.

Examination of Industry Payments to Radiation Oncologists in 2014 Using the Centers for Medicare and Medicaid Services Open Payments Database.

PubMed

Jairam, Vikram; Yu, James B

2016-01-01

To use the Centers for Medicare and Medicaid Services Open Payments database to characterize payments made to radiation oncologists and compare their payment profile with that of medical and surgical oncologists. The June 2015 release of the Open Payments database was accessed, containing all payments made to physicians in 2014. The general payments dataset was used for analysis. Data on payments made to medical, surgical, and radiation oncologists was obtained and compared. Within radiation oncology, data regarding payment category, sponsorship, and geographic distribution were identified. Basic statistics including mean, median, range, and sum were calculated by provider and by transaction. Among the 3 oncologic specialties, radiation oncology had the smallest proportion (58%) of compensated physicians and the lowest mean ($1620) and median ($112) payment per provider. Surgical oncology had the highest proportion (84%) of compensated physicians, whereas medical oncology had the highest mean ($6371) and median ($448) payment per physician. Within radiation oncology, nonconsulting services accounted for the most money to physicians ($1,042,556), whereas the majority of the sponsors were medical device companies (52%). Radiation oncologists in the West accepted the most money ($2,041,603) of any US Census region. Radiation oncologists in 2014 received a large number of payments from industry, although less than their medical or surgical counterparts. As the Open Payments database continues to be improved, it remains to be seen whether this information will be used by patients to inform choice of providers or by lawmakers to enact policy regulating physician-industry relationships. Copyright © 2016 Elsevier Inc. All rights reserved.

42 CFR 405.2462 - Payment for rural health clinic and Federally qualified health center services.

Code of Federal Regulations, 2011 CFR

2011-10-01

... SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM FEDERAL HEALTH INSURANCE FOR THE AGED... this chapter. (6) Payment for treatment of mental psychoneurotic or personality disorders is subject to...

MRI: update on technology diffusion and acquisition.

PubMed

Hoppszallern, S; Hughes, C; Zimmerman, R A

1991-04-01

Over the past three years, magnetic resonance imaging (MRI) has become accepted as a valuable diagnostic tool, and its applications continue to expand. During this time, the number of units installed in the United States doubled. By 1990 about 2,000 MRI units were in place in the United States and nearly 20 percent of the MRI-installed base was mobile, according to a research study conducted by the Hadley Hart Group (Chicago) and Drew Consultants, Inc. (Concord, MA). With the introduction of the prospective payment system, many hospitals were hesitant to spend limited capital on new technology, such as MRI. At the same time, freestanding diagnostic imaging centers were on the rise. Some hospitals and entrepreneurs who foresaw the potential of MRI in health care pioneered its use in the clinical setting. Hospitals began to examine new partnership arrangements and alternative forms of financing, so that they too could offer MRI services. By the end of 1988, the majority of hospitals offering MRI services did not own their own unit and about 40 percent of the hospitals offering MRI services were in a mobile configuration according to the Hadley Hart Group. While the technology has been diffused into 100-bed hospitals via mobile service vendors in some parts of the country, many medium-sized and large hospitals also have entered the MRI services market in this fashion. In the larger hospitals, the patient demand or need for the service often would justify acquisition of MRI, but the expense of the technology, and in many areas restrictive state health planning policies, modified purchase of MRI systems by hospitals. Mobile service vendors offered hospitals a way to startup MRI services in a limited fashion without a major capital expenditure and its associated risk. As hospitals gain experience with mobile MRI and achieve or exceed their early utilization projections, administrators are reevaluating the need to expand services to a full-time fixed site. Early fixed-site MRI providers have been constantly upgrading their MRI capability while planning on adding more units. The technology itself has continued to improve, primarily through the implementation of new software that permits new techniques such as MR angiography (MRA) to be performed. Units are available in a wide price range, price usually reflecting both the field strength (0.5 tesla units cost less) as well as the additional capabilities beyond routine imaging (MRA, spectroscopy).(ABSTRACT TRUNCATED AT 400 WORDS)

US approaches to physician payment: the deconstruction of primary care.

PubMed

Berenson, Robert A; Rich, Eugene C

2010-06-01

The purpose of this paper is to address why the three dominant alternatives to compensating physicians (fee-for-service, capitation, and salary) fall short of what is needed to support enhanced primary care in the patient-centered medical home, and the relevance of such payment reforms as pay-for-performance and episodes/bundling. The review illustrates why prevalent physician payment mechanisms in the US have failed to adequately support primary care and why innovative approaches to primary care payment play such a prominent role in the PCMH discussion. FFS payment for office visits has never effectively rewarded all the activities that comprise prototypical primary care and may contribute to the "hamster on a treadmill" problems in current medical practice. Capitation payments are associated with risk adjustment challenges and, perhaps, public perceptions of conflict with patients' best interests. Most payers don't employ and therefore cannot generally place physicians on salary; while in theory such salary payments might neutralize incentives, operationally, "time is money;" extra effort devoted to meeting the needs of a more complex patient will likely reduce the services available to others. Fee-for-service, the predominant physician payment scheme, has contributed to both the continuing decline in the primary care workforce and the capability to serve patients well. Yet, the conceptual alternative payment approaches, modified fee-for-service (including fee bundles), capitation, and salary, each have their own problems. Accordingly, new payment models will likely be required to support restoration of primary care to its proper role in the US health care system, and to promote and sustain the development of patient-centered medical homes.

47 CFR 1.1104 - Schedule of charges for applications and other filings for media services.

Code of Federal Regulations, 2013 CFR

2013-10-01

... filings for media services. 1.1104 Section 1.1104 Telecommunication FEDERAL COMMUNICATIONS COMMISSION... Payment § 1.1104 Schedule of charges for applications and other filings for media services. Remit manual filings and/or payment for these services to the: Federal Communications Commission, Media Bureau Services...

47 CFR 1.1104 - Schedule of charges for applications and other filings for media services.

Code of Federal Regulations, 2012 CFR

2012-10-01

... filings for media services. 1.1104 Section 1.1104 Telecommunication FEDERAL COMMUNICATIONS COMMISSION... Payment § 1.1104 Schedule of charges for applications and other filings for media services. Remit manual filings and/or payment for these services to the: Federal Communications Commission, Media Bureau Services...

42 CFR 405.207 - Services related to a noncovered device.

Code of Federal Regulations, 2010 CFR

2010-10-01

... SERVICES MEDICARE PROGRAM FEDERAL HEALTH INSURANCE FOR THE AGED AND DISABLED Medical Services Coverage Decisions That Relate to Health Care Technology § 405.207 Services related to a noncovered device. (a) When payment is not made. Medicare payment is not made for medical and hospital services that are related to...

42 CFR 413.333 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-10-01

... PROSPECTIVELY DETERMINED PAYMENT RATES FOR SKILLED NURSING FACILITIES Prospective Payment for Skilled Nursing... goods and services included in covered skilled nursing services. Resident classification system means a...

42 CFR 413.333 - Definitions.

Code of Federal Regulations, 2013 CFR

2013-10-01

... PROSPECTIVELY DETERMINED PAYMENT RATES FOR SKILLED NURSING FACILITIES Prospective Payment for Skilled Nursing... goods and services included in covered skilled nursing services. Resident classification system means a...

42 CFR 424.121 - Scope of payments.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 3 2011-10-01 2011-10-01 false Scope of payments. 424.121 Section 424.121 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED...' services and ambulance services furnished in connection with covered inpatient care in a foreign hospital...

42 CFR 424.121 - Scope of payments.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 3 2010-10-01 2010-10-01 false Scope of payments. 424.121 Section 424.121 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED...' services and ambulance services furnished in connection with covered inpatient care in a foreign hospital...

76 FR 77590 - Financial Management Service; Proposed Collection of Information: Request for Payment of Federal...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-12-13

... DEPARTMENT OF THE TREASURY Fiscal Service Financial Management Service; Proposed Collection of Information: Request for Payment of Federal Benefit by Check, EFT Waiver Form AGENCY: Financial Management... to Financial Management Service, 3700 East West Highway, Records and Information Management Branch...

7 CFR 1956.85 - Payments and receipts.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 7 Agriculture 14 2013-01-01 2013-01-01 false Payments and receipts. 1956.85 Section 1956.85 Agriculture Regulations of the Department of Agriculture (Continued) RURAL HOUSING SERVICE, RURAL BUSINESS-COOPERATIVE SERVICE, RURAL UTILITIES SERVICE, AND FARM SERVICE AGENCY, DEPARTMENT OF AGRICULTURE (CONTINUED) PROGRAM REGULATIONS (CONTINUED) DEBT...

7 CFR 1956.85 - Payments and receipts.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 7 Agriculture 14 2012-01-01 2012-01-01 false Payments and receipts. 1956.85 Section 1956.85 Agriculture Regulations of the Department of Agriculture (Continued) RURAL HOUSING SERVICE, RURAL BUSINESS-COOPERATIVE SERVICE, RURAL UTILITIES SERVICE, AND FARM SERVICE AGENCY, DEPARTMENT OF AGRICULTURE (CONTINUED) PROGRAM REGULATIONS (CONTINUED) DEBT...

7 CFR 1956.85 - Payments and receipts.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 14 2010-01-01 2009-01-01 true Payments and receipts. 1956.85 Section 1956.85 Agriculture Regulations of the Department of Agriculture (Continued) RURAL HOUSING SERVICE, RURAL BUSINESS-COOPERATIVE SERVICE, RURAL UTILITIES SERVICE, AND FARM SERVICE AGENCY, DEPARTMENT OF AGRICULTURE (CONTINUED) PROGRAM REGULATIONS (CONTINUED) DEBT...

7 CFR 1956.85 - Payments and receipts.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 7 Agriculture 14 2011-01-01 2011-01-01 false Payments and receipts. 1956.85 Section 1956.85 Agriculture Regulations of the Department of Agriculture (Continued) RURAL HOUSING SERVICE, RURAL BUSINESS-COOPERATIVE SERVICE, RURAL UTILITIES SERVICE, AND FARM SERVICE AGENCY, DEPARTMENT OF AGRICULTURE (CONTINUED) PROGRAM REGULATIONS (CONTINUED) DEBT...

7 CFR 1956.85 - Payments and receipts.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 7 Agriculture 14 2014-01-01 2014-01-01 false Payments and receipts. 1956.85 Section 1956.85 Agriculture Regulations of the Department of Agriculture (Continued) RURAL HOUSING SERVICE, RURAL BUSINESS-COOPERATIVE SERVICE, RURAL UTILITIES SERVICE, AND FARM SERVICE AGENCY, DEPARTMENT OF AGRICULTURE (CONTINUED) PROGRAM REGULATIONS (CONTINUED) DEBT...

42 CFR 415.130 - Conditions for payment: Physician pathology services.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 42 Public Health 3 2013-10-01 2013-10-01 false Conditions for payment: Physician pathology... pathology services. (a) Definitions. The following definitions are used in this section. (1) Covered... technical component of physician pathology services to fee-for-service Medicare beneficiaries who were...

42 CFR 415.130 - Conditions for payment: Physician pathology services.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 3 2012-10-01 2012-10-01 false Conditions for payment: Physician pathology... pathology services. (a) Definitions. The following definitions are used in this section. (1) Covered... technical component of physician pathology services to fee-for-service Medicare beneficiaries who were...

42 CFR 415.130 - Conditions for payment: Physician pathology services.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 3 2014-10-01 2014-10-01 false Conditions for payment: Physician pathology... pathology services. (a) Definitions. The following definitions are used in this section. (1) Covered... technical component of physician pathology services to fee-for-service Medicare beneficiaries who were...

Episode-Based Payment and Direct Employer Purchasing of Healthcare Services: Recent Bundled Payment Innovations and the Geisinger Health System Experience.

PubMed

Slotkin, Jonathan R; Ross, Olivia A; Newman, Eric D; Comrey, Janet L; Watson, Victoria; Lee, Rachel V; Brosious, Megan M; Gerrity, Gloria; Davis, Scott M; Paul, Jacquelyn; Miller, E Lynn; Feinberg, David T; Toms, Steven A

2017-04-01

One significant driver of the disjointed healthcare often observed in the United States is the traditional fee-for-service payment model which financially incentivizes the volume of care delivered over the quality and coordination of care. This problem is compounded by the wide, often unwarranted variation in healthcare charges that purchasers of health services encounter for substantially similar episodes of care. The last 10 years have seen many stakeholder organizations begin to experiment with novel financial payment models that strive to obviate many of the challenges inherent in customary quantity-based cost paradigms. The Patient Protection and Affordable Care Act has allowed many care delivery systems to partner with Medicare in episode-based payment programs such as the Bundled Payments for Care Improvement (BPCI) initiative, and in patient-based models such as the Medicare Shared Savings Program. Several employer purchasers of healthcare services are experimenting with innovative payment models to include episode-based bundled rate destination centers of excellence programs and the direct purchasing of accountable care organization services. The Geisinger Health System has over 10 years of experience with episode-based payment bundling coupled with the care delivery reengineering which is integral to its ProvenCare® program. Recent experiences at Geisinger have included participation in BPCI and also partnership with employer-purchasers of healthcare through the Pacific Business Group on Health (representing Walmart, Lowe's, and JetBlue Airways). As the shift towards value-focused care delivery and patient experience progresses forward, bundled payment arrangements and direct purchasing of healthcare will be critical financial drivers in effecting change. Copyright © 2017 by the Congress of Neurological Surgeons.

76 FR 78281 - Medicare Program; First Semi-Annual Meeting of the Advisory Panel on Hospital Outpatient Payment...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-12-16

... DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services [CMS-1586-N] Medicare Program; First Semi-Annual Meeting of the Advisory Panel on Hospital Outpatient Payment (HOP--Formerly Known as the Advisory Panel on Ambulatory Payment Classification Groups--APC Panel)--February 27...

42 CFR 412.521 - Basis of payment.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 2 2010-10-01 2010-10-01 false Basis of payment. 412.521 Section 412.521 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM... medical records requested by a QIO, in accordance with § 476.78(c) of this chapter. (c) Payment by workers...

42 CFR 412.79 - Determination of the hospital-specific rate for inpatient operating costs for Medicare-dependent...

Code of Federal Regulations, 2010 CFR

2010-10-01

... OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Determination of Transition Period Payment Rates for the Prospective Payment System for Inpatient... 42 Public Health 2 2010-10-01 2010-10-01 false Determination of the hospital-specific rate for...

25 CFR 20.313 - How will the Bureau compute financial assistance payments?

Code of Federal Regulations, 2010 CFR

2010-04-01

... 25 Indians 1 2010-04-01 2010-04-01 false How will the Bureau compute financial assistance payments? 20.313 Section 20.313 Indians BUREAU OF INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR HUMAN SERVICES... will the Bureau compute financial assistance payments? (a) The social services worker will compute...

78 FR 7764 - Information Collection; Submission for OMB Review, Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2013-02-04

... (ICR) entitled National Service Trust Interest Payment Form for review and approval in accordance with the Paperwork Reduction Act of 1995, Public Law 104-13, (44 U.S.C. Chapter 35). Copies of this ICR... Service Trust Interest Payment Form, which is used by AmeriCorps members to request interest payments on...

42 CFR 23.31 - May loan payments be postponed or waived?

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 1 2010-10-01 2010-10-01 false May loan payments be postponed or waived? 23.31 Section 23.31 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES PERSONNEL... payments be postponed or waived? (a) Whenever health, economic, or other personal problems affect the...

42 CFR 422.304 - Monthly payments.

Code of Federal Regulations, 2010 CFR

2010-10-01

...) MEDICARE PROGRAM MEDICARE ADVANTAGE PROGRAM Payments to Medicare Advantage Organizations § 422.304 Monthly... original fee-for-service benefits for an individual in an MA payment area for a month. (1) Payment of bid...

42 CFR § 414.1450 - APM incentive payment.

Code of Federal Regulations, 2010 CFR

2017-10-01

... (CONTINUED) MEDICARE PROGRAM (CONTINUED) PAYMENT FOR PART B MEDICAL AND OTHER HEALTH SERVICES Merit-Based Incentive Payment System and Alternative Payment Model Incentive § 414.1450 APM incentive payment. (a) In... 42 Public Health 3 2017-10-01 2017-10-01 false APM incentive payment. § 414.1450 Section § 414...

42 CFR § 414.1405 - Payment.

Code of Federal Regulations, 2010 CFR

2017-10-01

...) MEDICARE PROGRAM (CONTINUED) PAYMENT FOR PART B MEDICAL AND OTHER HEALTH SERVICES Merit-Based Incentive Payment System and Alternative Payment Model Incentive § 414.1405 Payment. (a) General. Each MIPS eligible... 42 Public Health 3 2017-10-01 2017-10-01 false Payment. § 414.1405 Section § 414.1405 Public...

42 CFR 422.322 - Source of payment and effect of MA plan election on payment.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 42 Public Health 3 2013-10-01 2013-10-01 false Source of payment and effect of MA plan election on... Medicare Advantage Organizations § 422.322 Source of payment and effect of MA plan election on payment. (a) Source of payments. (1) Payments under this subpart for original fee-for-service benefits to MA...

42 CFR 422.322 - Source of payment and effect of MA plan election on payment.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 3 2014-10-01 2014-10-01 false Source of payment and effect of MA plan election on... Medicare Advantage Organizations § 422.322 Source of payment and effect of MA plan election on payment. (a) Source of payments. (1) Payments under this subpart for original fee-for-service benefits to MA...

42 CFR 422.322 - Source of payment and effect of MA plan election on payment.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 3 2012-10-01 2012-10-01 false Source of payment and effect of MA plan election on... Medicare Advantage Organizations § 422.322 Source of payment and effect of MA plan election on payment. (a) Source of payments. (1) Payments under this subpart for original fee-for-service benefits to MA...

42 CFR 412.541 - Method of payment under the long-term care hospital prospective payment system.

Code of Federal Regulations, 2011 CFR

2011-10-01

...) Recovery of payment. Recovery of the accelerated payment is made by recoupment as long-term care hospital... 42 Public Health 2 2011-10-01 2011-10-01 false Method of payment under the long-term care hospital... SERVICES Prospective Payment System for Long-Term Care Hospitals § 412.541 Method of payment under the long...

42 CFR 412.541 - Method of payment under the long-term care hospital prospective payment system.

Code of Federal Regulations, 2014 CFR

2014-10-01

...) Recovery of payment. Recovery of the accelerated payment is made by recoupment as long-term care hospital... 42 Public Health 2 2014-10-01 2014-10-01 false Method of payment under the long-term care hospital... SERVICES Prospective Payment System for Long-Term Care Hospitals § 412.541 Method of payment under the long...

42 CFR 412.541 - Method of payment under the long-term care hospital prospective payment system.

Code of Federal Regulations, 2013 CFR

2013-10-01

...) Recovery of payment. Recovery of the accelerated payment is made by recoupment as long-term care hospital... 42 Public Health 2 2013-10-01 2013-10-01 false Method of payment under the long-term care hospital... SERVICES Prospective Payment System for Long-Term Care Hospitals § 412.541 Method of payment under the long...

42 CFR 412.541 - Method of payment under the long-term care hospital prospective payment system.

Code of Federal Regulations, 2010 CFR

2010-10-01

...) Recovery of payment. Recovery of the accelerated payment is made by recoupment as long-term care hospital... 42 Public Health 2 2010-10-01 2010-10-01 false Method of payment under the long-term care hospital... SERVICES Prospective Payment System for Long-Term Care Hospitals § 412.541 Method of payment under the long...

42 CFR 412.541 - Method of payment under the long-term care hospital prospective payment system.

Code of Federal Regulations, 2012 CFR

2012-10-01

...) Recovery of payment. Recovery of the accelerated payment is made by recoupment as long-term care hospital... 42 Public Health 2 2012-10-01 2012-10-01 false Method of payment under the long-term care hospital... SERVICES Prospective Payment System for Long-Term Care Hospitals § 412.541 Method of payment under the long...

42 CFR § 512.700 - Basis and scope.

Code of Federal Regulations, 2010 CFR

2017-10-01

... (CONTINUED) HEALTH CARE INFRASTRUCTURE AND MODEL PROGRAMS EPISODE PAYMENT MODEL CR Incentive Payment Model... implements the cardiac rehabilitation (CR) and intensive cardiac rehabilitation (ICR) incentive payment model... in the CR incentive payment model. (2) The CR/ICR services that count toward CR incentive payments...

42 CFR § 414.1300 - Basis and scope.

Code of Federal Regulations, 2010 CFR

2017-10-01

... Incentive Payment System and Alternative Payment Model Incentive § 414.1300 Basis and scope. (a) Basis. This... Participation in Eligible Alternative Payment Models. (2) Section 1848(a)—Payment for Physicians' Services Based... to QPs. (10) Criteria for Physician-Focused Payment Models (PFPMs). ...

42 CFR 414.620 - Publication of the ambulance fee schedule.

Code of Federal Regulations, 2010 CFR

2010-10-01

... Section 414.620 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM PAYMENT FOR PART B MEDICAL AND OTHER HEALTH SERVICES Fee Schedule for Ambulance Services § 414.620 Publication of the ambulance fee schedule. Changes in payment rates resulting...

42 CFR 410.172 - Payment for partial hospitalization services in CMHCs: Conditions.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 2 2010-10-01 2010-10-01 false Payment for partial hospitalization services in CMHCs: Conditions. 410.172 Section 410.172 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM SUPPLEMENTARY MEDICAL INSURANCE (SMI) BENEFITS...

41 CFR 105-60.305-9 - Form of payment.

Code of Federal Regulations, 2010 CFR

2010-07-01

... Regulations System (Continued) GENERAL SERVICES ADMINISTRATION Regional Offices-General Services..., Orders, Policies, Interpretations, Manuals, and Instructions § 105-60.305-9 Form of payment. Requesters...

41 CFR 105-60.305-9 - Form of payment.

Code of Federal Regulations, 2011 CFR

2011-01-01

... Regulations System (Continued) GENERAL SERVICES ADMINISTRATION Regional Offices-General Services..., Orders, Policies, Interpretations, Manuals, and Instructions § 105-60.305-9 Form of payment. Requesters...

47 CFR 54.638 - Upfront payments.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 47 Telecommunication 3 2014-10-01 2014-10-01 false Upfront payments. 54.638 Section 54.638 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) COMMON CARRIER SERVICES (CONTINUED) UNIVERSAL SERVICE Universal Service Support for Health Care Providers Healthcare Connect Fund § 54.638 Upfront...

47 CFR 54.638 - Upfront payments.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 47 Telecommunication 3 2013-10-01 2013-10-01 false Upfront payments. 54.638 Section 54.638 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) COMMON CARRIER SERVICES (CONTINUED) UNIVERSAL SERVICE Universal Service Support for Health Care Providers Healthcare Connect Fund § 54.638 Upfront...

Quick-Reaction Report on the Audit of ReCoupment Actions on Medicine Payments to Uniformed Services Treatment Facilities.

DTIC Science & Technology

1993-07-21

OFFICE OF THE INSPECTOR GENERAL QUICK-REACTION REPORT ON THE AUDIT OF RECOUPMENT ACTIONS ON MEDICARE PAYMENTS TO UNIFORMED SERVICES TREATMENT...Quick-Reaction Report on the Audit of Recoupment Actions on Medicare Payments to Uniformed Services Treatment Facilities (Report No. 93-150) We are...Inspectors General will provide a joint report to the congressional committees that requested the audit . The courtesies extended to the audit staff

[Different forms of payment systems for dental services and their impact on care].

PubMed

Sória, Marina Lara; Bordin, Ronaldo; da Costa Filho, Luiz Cesar

2002-01-01

The Brazilian dental care sector is facing a paradoxical crisis characterized by a surplus of dentists and a large contingent of people lacking dental care, thus highlighting the need to improve management strategies. One necessary step is to analyze the various payment schemes for dental services. This paper reviews two important approaches, fee for service and capitation, and considers the impacts and consequences of payment strategies on the dental care system.

42 CFR 410.170 - Payment for home health services, for medical and other health services furnished by a provider...

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 2 2010-10-01 2010-10-01 false Payment for home health services, for medical and other health services furnished by a provider or an approved ESRD facility, and for comprehensive outpatient rehabilitation facility (CORF) services: Conditions. 410.170 Section 410.170 Public Health CENTERS...

41 CFR 105-60.305-7 - Assurance of payment.

Code of Federal Regulations, 2010 CFR

2010-07-01

... Regulations System (Continued) GENERAL SERVICES ADMINISTRATION Regional Offices-General Services..., Orders, Policies, Interpretations, Manuals, and Instructions § 105-60.305-7 Assurance of payment. If fees...

41 CFR 105-60.305-7 - Assurance of payment.

Code of Federal Regulations, 2011 CFR

2011-01-01

... Regulations System (Continued) GENERAL SERVICES ADMINISTRATION Regional Offices-General Services..., Orders, Policies, Interpretations, Manuals, and Instructions § 105-60.305-7 Assurance of payment. If fees...

42 CFR 412.2 - Basis of payment.

Code of Federal Regulations, 2011 CFR

2011-10-01

... services furnished to Medicare beneficiaries. The prospective payment rate for each discharge (as defined... the election in § 405.521 of this chapter. (4) The acquisition costs of hearts, kidneys, livers, lungs... payments to hospitals. In addition to payments based on the prospective payment system rates for inpatient...

42 CFR 412.2 - Basis of payment.

Code of Federal Regulations, 2014 CFR

2014-10-01

... services furnished to Medicare beneficiaries. The prospective payment rate for each discharge (as defined... the election in § 405.521 of this chapter. (4) The acquisition costs of hearts, kidneys, livers, lungs... payments to hospitals. In addition to payments based on the prospective payment system rates for inpatient...

42 CFR 412.2 - Basis of payment.

Code of Federal Regulations, 2013 CFR

2013-10-01

... services furnished to Medicare beneficiaries. The prospective payment rate for each discharge (as defined... the election in § 405.521 of this chapter. (4) The acquisition costs of hearts, kidneys, livers, lungs... payments to hospitals. In addition to payments based on the prospective payment system rates for inpatient...

42 CFR 412.2 - Basis of payment.

Code of Federal Regulations, 2012 CFR

2012-10-01

... services furnished to Medicare beneficiaries. The prospective payment rate for each discharge (as defined... the election in § 405.521 of this chapter. (4) The acquisition costs of hearts, kidneys, livers, lungs... payments to hospitals. In addition to payments based on the prospective payment system rates for inpatient...

42 CFR 412.2 - Basis of payment.

Code of Federal Regulations, 2010 CFR

2010-10-01

... services furnished to Medicare beneficiaries. The prospective payment rate for each discharge (as defined... the election in § 405.521 of this chapter. (4) The acquisition costs of hearts, kidneys, livers, lungs... payments to hospitals. In addition to payments based on the prospective payment system rates for inpatient...

42 CFR 416.167 - Basis of payment.

Code of Federal Regulations, 2010 CFR

2010-10-01

... classification (APC) groups and payment weights. (1) ASC covered surgical procedures are classified using the APC... section, an ASC relative payment weight is determined based on the APC relative payment weight for each covered surgical procedure and covered ancillary service that has an applicable APC relative payment...

Trends in Medicare Service Volume for Cataract Surgery and the Impact of the Medicare Physician Fee Schedule.

PubMed

Gong, Dan; Jun, Lin; Tsai, James C

2017-08-01

To calculate the associations between Medicare payment and service volume for complex and noncomplex cataract surgeries. The 2005-2009 CMS Part B National Summary Data Files, CMS Part B Carrier Summary Data Files, and the Medicare Physician Fee Schedule. Conducting a retrospective, longitudinal analysis using a fixed-effects model of Medicare Part B carriers representing all 50 states and the District of Columbia from 2005 to 2009, we calculated the Medicare payment-service volume elasticities for noncomplex (CPT 66984) and complex (CPT 66982) cataract surgeries. Service volume data were extracted from the CMS Part B National Summary and Carrier Summary Data Files. Payment data were extracted from the Medicare Physician Fee Schedule. From 2005 to 2009, the proportion of total cataract services billed as complex increased from 3.2 to 6.7 percent. Every 1 percent decrease in Medicare payment was associated with a nonsignificant change in noncomplex cataract service volume (elasticity = 0.15, 95 percent CI [-0.09, 0.38]) but a statistically significant increase in complex cataract service volume (elasticity = -1.12, 95 percent CI [-1.60, -0.63]). Reduced Medicare payment was associated with a significant increase in complex cataract service volume but not in noncomplex cataract service volume, resulting in a shift toward performing a greater proportion of complex cataract surgeries from 2005 to 2009. © Health Research and Educational Trust.

Effects of New Funding Models for Patient-Centered Medical Homes on Primary Care Practice Finances and Services: Results of a Microsimulation Model.

PubMed

Basu, Sanjay; Phillips, Russell S; Song, Zirui; Landon, Bruce E; Bitton, Asaf

2016-09-01

We assess the financial implications for primary care practices of participating in patient-centered medical home (PCMH) funding initiatives. We estimated practices' changes in net revenue under 3 PCMH funding initiatives: increased fee-for-service (FFS) payments, traditional FFS with additional per-member-per-month (PMPM) payments, or traditional FFS with PMPM and pay-for-performance (P4P) payments. Net revenue estimates were based on a validated microsimulation model utilizing national practice surveys. Simulated practices reflecting the national range of practice size, location, and patient population were examined under several potential changes in clinical services: investments in patient tracking, communications, and quality improvement; increased support staff; altered visit templates to accommodate longer visits, telephone visits or electronic visits; and extended service delivery hours. Under the status quo of traditional FFS payments, clinics operate near their maximum estimated possible net revenue levels, suggesting they respond strongly to existing financial incentives. Practices gained substantial additional net annual revenue per full-time physician under PMPM or PMPM plus P4P payments ($113,300 per year, 95% CI, $28,500 to $198,200) but not under increased FFS payments (-$53,500, 95% CI, -$69,700 to -$37,200), after accounting for costs of meeting PCMH funding requirements. Expanding services beyond minimum required levels decreased net revenue, because traditional FFS revenues decreased. PCMH funding through PMPM payments could substantially improve practice finances but will not offer sufficient financial incentives to expand services beyond minimum requirements for PCMH funding. © 2016 Annals of Family Medicine, Inc.

Community oncology in an era of payment reform.

PubMed

Cox, John V; Ward, Jeffery C; Hornberger, John C; Temel, Jennifer S; McAneny, Barbara L

2014-01-01

Patients and payers (government and private) are frustrated with the fee-for-service system (FFS) of payment for outpatient health services. FFS rewards volume and highly valued services, including expensive diagnostics and therapeutics, over lesser valued cognitive services. Proposed payment schemes would incent collaboration and coordination of care among providers and reward quality. In oncology, new payment schemes must address the high costs of all services, particularly drugs, while preserving the robust distribution of sites of service available to patients in the United States. Information technology and personalized cancer care are changing the practice of oncology. Twenty-first century oncology will require increasing cognitive work and shared decision making, both of which are not well regarded in the FFS model. A high proportion of health care dollars are consumed in the final months of life. Effective delivery of palliative and end-of-life care must be addressed by practice and by new models of payment. Value-based reimbursement schemes will require oncology practices to change how they are structured. Lessons drawn from the principles of primary care's Patient Centered Medical Home (PCMH) will help oncology practice to prepare for new schemes. PCMH principles place a premium on proactively addressing toxicities of therapies, coordinating care with other providers, and engaging patients in shared decision making, supporting the ideal of value defined in the triple aim-to measurably improve patient experience and quality of care at less cost. Payment reform will be disruptive to all. Oncology must be engaged in policy discussions and guide rational shifts in priorities defined by new payment models.

Effects of New Funding Models for Patient-Centered Medical Homes on Primary Care Practice Finances and Services: Results of a Microsimulation Model

PubMed Central

Basu, Sanjay; Phillips, Russell S.; Song, Zirui; Landon, Bruce E.; Bitton, Asaf

2016-01-01

PURPOSE We assess the financial implications for primary care practices of participating in patient-centered medical home (PCMH) funding initiatives. METHODS We estimated practices’ changes in net revenue under 3 PCMH funding initiatives: increased fee-for-service (FFS) payments, traditional FFS with additional per-member-per-month (PMPM) payments, or traditional FFS with PMPM and pay-for-performance (P4P) payments. Net revenue estimates were based on a validated microsimulation model utilizing national practice surveys. Simulated practices reflecting the national range of practice size, location, and patient population were examined under several potential changes in clinical services: investments in patient tracking, communications, and quality improvement; increased support staff; altered visit templates to accommodate longer visits, telephone visits or electronic visits; and extended service delivery hours. RESULTS Under the status quo of traditional FFS payments, clinics operate near their maximum estimated possible net revenue levels, suggesting they respond strongly to existing financial incentives. Practices gained substantial additional net annual revenue per full-time physician under PMPM or PMPM plus P4P payments ($113,300 per year, 95% CI, $28,500 to $198,200) but not under increased FFS payments (−$53,500, 95% CI, −$69,700 to −$37,200), after accounting for costs of meeting PCMH funding requirements. Expanding services beyond minimum required levels decreased net revenue, because traditional FFS revenues decreased. CONCLUSIONS PCMH funding through PMPM payments could substantially improve practice finances but will not offer sufficient financial incentives to expand services beyond minimum requirements for PCMH funding. PMID:27621156

Examination of Industry Payments to Radiation Oncologists in 2014 Using the Centers for Medicare and Medicaid Services Open Payments Database

DOE Office of Scientific and Technical Information (OSTI.GOV)

Jairam, Vikram; Yu, James B., E-mail: james.b.yu@yale.edu

Purpose: To use the Centers for Medicare and Medicaid Services Open Payments database to characterize payments made to radiation oncologists and compare their payment profile with that of medical and surgical oncologists. Methods and Materials: The June 2015 release of the Open Payments database was accessed, containing all payments made to physicians in 2014. The general payments dataset was used for analysis. Data on payments made to medical, surgical, and radiation oncologists was obtained and compared. Within radiation oncology, data regarding payment category, sponsorship, and geographic distribution were identified. Basic statistics including mean, median, range, and sum were calculated by providermore » and by transaction. Results: Among the 3 oncologic specialties, radiation oncology had the smallest proportion (58%) of compensated physicians and the lowest mean ($1620) and median ($112) payment per provider. Surgical oncology had the highest proportion (84%) of compensated physicians, whereas medical oncology had the highest mean ($6371) and median ($448) payment per physician. Within radiation oncology, nonconsulting services accounted for the most money to physicians ($1,042,556), whereas the majority of the sponsors were medical device companies (52%). Radiation oncologists in the West accepted the most money ($2,041,603) of any US Census region. Conclusions: Radiation oncologists in 2014 received a large number of payments from industry, although less than their medical or surgical counterparts. As the Open Payments database continues to be improved, it remains to be seen whether this information will be used by patients to inform choice of providers or by lawmakers to enact policy regulating physician–industry relationships.« less

Strategic interaction among hospitals and nursing facilities: the efficiency effects of payment systems and vertical integration.

PubMed

Banks, D; Parker, E; Wendel, J

2001-03-01

Rising post-acute care expenditures for Medicare transfer patients and increasing vertical integration between hospitals and nursing facilities raise questions about the links between payment system structure, the incentive for vertical integration and the impact on efficiency. In the United States, policy-makers are responding to these concerns by initiating prospective payments to nursing facilities, and are exploring the bundling of payments to hospitals. This paper develops a static profit-maximization model of the strategic interaction between the transferring hospital and a receiving nursing facility. This model suggests that the post-1984 system of prospective payment for hospital care, coupled with nursing facility payments that reimburse for services performed, induces inefficient under-provision of hospital services and encourages vertical integration. It further indicates that the extension of prospective payment to nursing facilities will not eliminate the incentive to vertically integrate, and will not result in efficient production unless such integration takes place. Bundling prospective payments for hospitals and nursing facilities will neither remove the incentive for vertical integration nor induce production efficiency without such vertical integration. However, bundled payment will induce efficient production, with or without vertical integration, if nursing facilities are reimbursed for services performed. Copyright 2001 John Wiley & Sons, Ltd.

26 CFR 1.113-1 - Mustering-out payments for members of the Armed Forces.

Code of Federal Regulations, 2010 CFR

2010-04-01

... Forces. 1.113-1 Section 1.113-1 Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT OF THE TREASURY....113-1 Mustering-out payments for members of the Armed Forces. For the purposes of the exclusion from gross income under section 113 of mustering-out payments with respect to service in the Armed Forces...

75 FR 74620 - Real Estate Settlement Procedures Act (RESPA): Home Warranty Companies' Payments to Real Estate...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-12-01

... interpretive rule concluded: (1) A payment by an HWC for marketing services performed by real estate brokers or... real estate broker or agent for marketing a home warranty product directly to particular homebuyers or... rule, payments for marketing services directed to particular homebuyers or sellers are considered to be...

42 CFR 457.616 - Application and tracking of payments against the fiscal year allotments.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 42 Public Health 4 2013-10-01 2013-10-01 false Application and tracking of payments against the fiscal year allotments. 457.616 Section 457.616 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) STATE CHILDREN'S HEALTH INSURANCE PROGRAMS (SCHIPs) ALLOTMENTS AND GRANTS TO STATES Payments to...

42 CFR 457.616 - Application and tracking of payments against the fiscal year allotments.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 4 2010-10-01 2010-10-01 false Application and tracking of payments against the fiscal year allotments. 457.616 Section 457.616 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) STATE CHILDREN'S HEALTH INSURANCE PROGRAMS (SCHIPs) ALLOTMENTS AND GRANTS TO STATES Payments to...