Sample records for procedure combination-based payment

  1. Evidence-Based Imaging Guidelines and Medicare Payment Policy

    PubMed Central

    Sistrom, Christopher L; McKay, Niccie L

    2008-01-01

    Objective This study examines the relationship between evidence-based appropriateness criteria for neurologic imaging procedures and Medicare payment determinations. The primary research question is whether Medicare is more likely to pay for imaging procedures as the level of appropriateness increases. Data Sources The American College of Radiology Appropriateness Criteria (ACRAC) for neurological imaging, ICD-9-CM codes, CPT codes, and payment determinations by the Medicare Part B carrier for Florida and Connecticut. Study Design Cross-sectional study of appropriateness criteria and Medicare Part B payment policy for neurological imaging. In addition to descriptive and bivariate statistics, multivariate logistic regression on payment determination (yes or no) was performed. Data Collection Methods The American College of Radiology Appropriateness Criteria (ACRAC) documents specific to neurological imaging, ICD-9-CM codes, and CPT codes were used to create 2,510 medical condition/imaging procedure combinations, with associated appropriateness scores (coded as low/middle/high). Principal Findings As the level of appropriateness increased, more medical condition/imaging procedure combinations were payable (low = 61 percent, middle = 70 percent, and high = 74 percent). Logistic regression indicated that the odds of a medical condition/imaging procedure combination with a middle level of appropriateness being payable was 48 percent higher than for an otherwise similar combination with a low appropriateness score (95 percent CI on odds ratio=1.19–1.84). The odds ratio for being payable between high and low levels of appropriateness was 2.25 (95 percent CI: 1.66–3.04). Conclusions Medicare could improve its payment determinations by taking advantage of existing clinical guidelines, appropriateness criteria, and other authoritative resources for evidence-based practice. Such an approach would give providers a financial incentive that is aligned with best-practice medicine. In particular, Medicare should review and update its payment policies to reflect current information on the appropriateness of alternative imaging procedures for the same medical condition. PMID:18454778

  2. Impact of the Japanese Diagnosis Procedure Combination-based Payment System on cardiovascular medicine-related costs.

    PubMed

    Yasunaga, Hideo; Ide, Hiroo; Imamura, Tomoaki; Ohe, Kazuhiko

    2005-09-01

    In 2003, a lump-sum payment system based on Diagnosis Procedure Combinations (DPC) was introduced to 82 specific function hospitals in Japan. While the US DRG/PPS system is a "per case payment" system, the DPC based payment system adopts a "per day payment." It is generally believed that the Japanese system provides as much of an incentive as the DRG/PPS system to shorten the average length of stay (LOS). We performed an empirical analysis of the effect of LOS shortening on hospital revenue and expenditure under the DPC-based payment system, particularly in cardiovascular diseases. We also point out fundamentally controversial aspects of the current system. A total 109 cases were selected from patients hospitalized at the University of Tokyo Hospital from May to July, 2003 and classified into one of three categories: (1) cardiac catheter interventions, (2) cardiac catheter examinations, and (3) other conservative treatments. We analyzed the changes in profit per day in cases of a reduction in average LOS and an increase in the number of cases. In category (1) profit increased significantly in conjunction with reduced LOS. In category (2) profit increased only minimally. In category (3), profit increased rarely and sometimes decreased. In cases of conservative treatment, profits sometimes decreased because an increase in material costs exceeded the increase in revenue. It therefore became clear that the DPC-based payment system does not decisively provide an economic incentive to reduce LOS in cardiovascular medicine.

  3. 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

  4. 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.

  5. 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...

  6. Using Medical Claims for Policy Effectiveness Surveillance: Reimbursement and Utilization of Abdomen/Pelvis Computed Tomography Scans.

    PubMed

    Horný, Michal; Morgan, Jake R; Merker, Vanessa L

    2015-12-01

    To quantify changes in private insurance payments for and utilization of abdominal/pelvic computed tomography scans (CTs) after 2011 changes in CPT coding and Medicare reimbursement rates, which were designed to reduce costs stemming from misvalued procedures. TruvenHealth Analytics MarketScan Commercial Claims and Encounters database. We used difference-in-differences models to compare combined CTs of the abdomen/pelvis to CTs of the abdomen or pelvis only. Our main outcomes were inflation-adjusted log payments per procedure, daily utilization rates, and total annual payments. Claims data were extracted for all abdominal/pelvic CTs performed in 2009-2011 within noncapitated, employer-sponsored private plans. Adjusted payments per combined CTs of the abdomen/pelvis dropped by 23.8 percent (p < .0001), and their adjusted daily utilization rate accelerated by 0.36 percent (p = .034) per month after January 2011. Utilization rate of abdominal-only or pelvic-only CTs dropped by 5.0 percent (p < .0001). Total annual payments for combined CTs of the abdomen/pelvis decreased in 2011 despite the increased utilization. Private insurance payments for combined CTs of the abdomen/pelvis declined and utilization accelerated significantly after 2011 policy changes. While growth in total annual payments was contained in 2011, it may not be sustained if 2011 utilization trends persist. © Health Research and Educational Trust.

  7. A real world analysis of payment per unit time in a Maryland Vascular Practice.

    PubMed

    Martin, John D; Warble, Patricia B; Hupp, Jon A; Mapes, Jerry E; Stanziale, Stephen F; Weiss, Linda L; Schiller, Toni B; Hanson, Louise A

    2010-10-01

    In 1992, Centers for Medicare and Medicaid Services instituted the Resource Based Relative Value Scale (RBRVS) system to determine physician reimbursement. Relative value units (RVU) were assigned to each Current Procedure Terminology (CPT) code and intended to reflect the time and intensity of work. Little data exist correlating actual procedural and clinical time with respect to reimbursement within the RVU value system. The purpose of this study was to determine how well this system distributes payments per hour for hospital-based procedures in a single vascular practice in the state of Maryland between July 1, 2008 and June 30, 2009. As part of an ongoing prospective outcomes program, procedural times for all vascular procedures (time into until time out of room) were recorded. Fifteen minutes were added for administrative functions on procedural day, each hospital day, and office visits during the global period. The combination of all times was reflected in the total care time (TCT) for each procedure. We recorded all physician fees collected for each procedure. This total fee collected for each procedure was then divided by the TCT to determine the procedure-specific payment per unit time. All similar procedures were grouped together and the average reimbursement per procedure was reported. Data was collected on all 1103 procedures performed during this period. Insurance carrier distribution was 75% Medicare and 25% private insurance. The average reimbursement was $316/hour for open procedures and $556/hour for endovascular. Higher reimbursing procedures included visceral endovascular procedures ($701/hour) and caval filters ($751/hour). Lower reimbursing procedures included lower extremity bypass ($292/hour), dialysis access ($268/hour) and lower extremity amputations ($223/hour). Striking was the difference between payment based on approach for similar conditions. Reimbursement for carotid stent vs carotid endarterectomy was $643/hour vs $383/hour, endovascular abdominal aortic aneurysm (AAA) repair vs open $593/hour vs $359/hour. This unique study demonstrates a "real world" experience of reimbursement per unit time and raises questions as to the validity of the RBRVS process. The disparity between payments for open and endovascular repair of similar conditions are typical of this inequality. These data do not reflect the intangible time of operative planning, administrative matters, or overhead, and these factors must be considered when interpreting this data. Regardless, this study suggests that capturing detailed financial data is possible and is a more accurate source for future discussions on reimbursement. Copyright © 2010 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.

  8. A model to determine payments associated with radiology procedures.

    PubMed

    Mabotuwana, Thusitha; Hall, Christopher S; Thomas, Shiby; Wald, Christoph

    2017-12-01

    Across the United States, there is a growing number of patients in Accountable Care Organizations and under risk contracts with commercial insurance. This is due to proliferation of new value-based payment models and care delivery reform efforts. In this context, the business model of radiology within a hospital or health system context is shifting from a primary profit-center to a cost-center with a goal of cost savings. Radiology departments need to increasingly understand how the transactional nature of the business relates to financial rewards. The main challenge with current reporting systems is that the information is presented only at an aggregated level, and often not broken down further, for instance, by type of exam. As such, the primary objective of this research is to provide better visibility into payments associated with individual radiology procedures in order to better calibrate expense/capital structure of the imaging enterprise to the actual revenue or value-add to the organization it belongs to. We propose a methodology that can be used to determine technical payments at a procedure level. We use a proportion based model to allocate payments to individual radiology procedures based on total charges (which also includes non-radiology related charges). Using a production dataset containing 424,250 radiology exams we calculated the overall average technical charge for Radiology to be $873.08 per procedure and the corresponding average payment to be $326.43 (range: $48.27 for XR and $2750.11 for PET/CT) resulting in an average payment percentage of 37.39% across all exams. We describe how charges associated with a procedure can be used to approximate technical payments at a more granular level with a focus on Radiology. The methodology is generalizable to approximate payment for other services as well. Understanding payments associated with each procedure can be useful during strategic practice planning. Charge-to-total charge ratio can be used to approximate radiology payments at a procedure level. Copyright © 2017 Elsevier B.V. All rights reserved.

  9. Surgical Procedures in Health Professional Shortage Areas: Impact of a Surgical Incentive Payment Plan.

    PubMed

    Diaz, Adrian; Merath, Katiuscha; Bagante, Fabio; Chen, Qinyu; Akgul, Ozgur; Beal, Eliza; Idrees, Jay; Olsen, Griffin; Gani, Faiz; Pawlik, Timothy M

    2018-05-15

    The Affordable Care Act established a Center for Medicare/Medicaid Services based 10% reimbursement bonus for general surgeons in Health Professional Shortage Areas. We sought to assess the impact of the Affordable Care Act Surgery Incentive Payment on surgical procedures performed in Health Professional Shortage Areas. Hospital utilization data from the California Office of Statewide Health Planning and Development between January 1, 2006, and December 31, 2015, were used to categorize hospitals according to Health Professional Shortage Area location. A difference-in-differences analysis measured the effect of the Surgery Incentive Payment on year-to-year differences for inpatient and outpatient surgical procedures by hospital type pre- (2006-2010) versus post- (2011-2015) Surgery Incentive Payment implementation. Among 409 unique hospitals that performed surgical procedures for at least 1 year of the study period, 2 performed surgery in a designated Health Professional Shortage Area. The two Health Professional Shortage Area -designated hospitals were located in a rural area, were non-teaching hospitals, and had 196 and 202 hospital beds, respectively. After the enactment of the Surgery Incentive Payment, while non- Health Professional Shortage Areas had only a modest relative decrease in total inpatient procedures (Pre-Surgery Incentive Payment: 4,666,938 versus Post-Surgery Incentive Payment: 4,451,612; Δ-4.6%), the proportional decrease in inpatient surgical procedures at Health Professional Shortage Area hospitals was more marked (Pre-Surgery Incentive Payment: 25,830 versus Post-Surgery Incentive Payment: 21,503; Δ-16.7%). In contrast, Health Professional Shortage Area hospitals proportionally had a greater increase in total outpatient procedures (Pre-Surgery Incentive Payment: 17,840 versus Post-Surgery Incentive Payment: 22,375: Δ+25.4%) versus non- Health Professional Shortage Area hospitals (Pre-Surgery Incentive Payment: 5,863,300 versus Post-Surgery Incentive Payment: 6,156,138; Δ+4.9%). Based on the difference-in-differences analysis, the increase in the trend of surgical procedures at Health Professional Shortage Area hospitals was much more notable after Surgery Incentive Payment implementation (Δ+75.2%). The Medicare Surgery Incentive Payment program was associated with an increase in the number of surgical procedures performed at Health Professional Shortage Area hospitals relative to non-Health Professional Shortage Area hospitals during the study period, reversing the trend from negative to positive. Copyright © 2018 Elsevier Inc. All rights reserved.

  10. 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...

  11. 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...

  12. 76 FR 32815 - Medicaid Program; Payment Adjustment for Provider-Preventable Conditions Including Health Care...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-06-06

    ... Hospital IPPS Inpatient prospective payment system MS-DRG Diagnosis-related group NCA National coverage... based on the ``inpatient prospective payment system'' (IPPS) described in section 1886(d) of the Act... and procedures, and payment systems. We reviewed various articles, reports, summaries, and data bases...

  13. 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...

  14. Paying for quality not quantity: a wisconsin health maintenance organization proposes an incentive model for reimbursement of chiropractic services.

    PubMed

    Pursel, Kevin J; Jacobson, Martin; Stephenson, Kathy

    2012-07-01

    The purpose of this study is to describe a reimbursement model that was developed by one Health Maintenance Organization (HMO) to transition from fee-for-service to add a combination of pay for performance and reporting model of reimbursement for chiropractic care. The previous incentive program used by the HMO provided best-practice education and additional reimbursement incentives for achieving the National Committee for Quality Assurance Back Pain Recognition Program (NCQA-BPRP) recognition status. However, this model had not leveled costs between doctors of chiropractic (DCs). Therefore, the HMO management aimed to develop a reimbursement model to incentivize providers to embrace existing best-practice models and report existing quality metrics. The development goals included the following: it should (1) be as financially predictable as the previous system, (2) cost no more on a per-member basis, (3) meet the coverage needs of its members, and (4) be able to be operationalized. The model should also reward DCs who embraced best practices with compensation, not simply tied to providing more procedures, the new program needed to (1) cause little or no disruption in current billing, (2) be grounded achievable and defined expectations for improvement in quality, and (3) be voluntary, without being unduly punitive, should the DC choose not to participate in the program. The generated model was named the Comprehensive Chiropractic Quality Reimbursement Methodology (CCQRM; pronounced "Quorum"). In this hybrid model, additional reimbursement, beyond pay-for-procedures will be based on unique payment interpretations reporting selected, existing Physician Quality Reporting System (PQRS) codes, meaningful use of electronic health records, and achieving NCQA-BPRP recognition. This model aims to compensate providers using pay-for-performance, pay-for-quality reporting, pay-for-procedure methods. The CCQRM reimbursement model was developed to address the current needs of one HMO that aims to transition from fee-for-service to a pay-for-performance and quality reporting for reimbursement for chiropractic care. This model is theoretically based on the combination of a fee-for-service payment, pay for participation (NCQA Back Pain Recognition Program payment), meaningful use of electronic health record payment, and pay for reporting (PQRS-BPMG payment). Evaluation of this model needs to be implemented to determine if it will achieve its intended goals. Copyright © 2012 National University of Health Sciences. Published by Mosby, Inc. All rights reserved.

  15. Doing More for More: Unintended Consequences of Financial Incentives for Oncology Specialty Care.

    PubMed

    O'Neil, Brock; Graves, Amy J; Barocas, Daniel A; Chang, Sam S; Penson, David F; Resnick, Matthew J

    2016-02-01

    Specialty care remains a significant contributor to health care spending but largely unaddressed in novel payment models aimed at promoting value-based delivery. Bladder cancer, chiefly managed by subspecialists, is among the most costly. In 2005, Centers for Medicare and Medicaid Services (CMS) dramatically increased physician payment for office-based interventions for bladder cancer to shift care from higher cost facilities, but the impact is unknown. This study evaluated the effect of financial incentives on patterns of fee-for-service (FFS) bladder cancer care. Data from a 5% sample of Medicare beneficiaries from 2001-2013 were evaluated using interrupted time-series analysis with segmented regression. Primary outcomes were the effects of CMS fee modifications on utilization and site of service for procedures associated with the diagnosis and treatment of bladder cancer. Rates of related bladder cancer procedures that were not affected by the fee change were concurrent controls. Finally, the effect of payment changes on both diagnostic yield and need for redundant procedures were studied. All statistical tests were two-sided. Utilization of clinic-based procedures increased by 644% (95% confidence interval [CI] = 584% to 704%) after the fee change, but without reciprocal decline in facility-based procedures. Procedures unaffected by the fee incentive remained unchanged throughout the study period. Diagnostic yield decreased by 17.0% (95% CI = 12.7% to 21.3%), and use of redundant office-based procedures increased by 76.0% (95% CI = 59% to 93%). Financial incentives in bladder cancer care have unintended and costly consequences in the current FFS environment. The observed price sensitivity is likely to remain a major issue in novel payment models failing to incorporate procedure-based specialty physicians. © The Author 2015. Published by Oxford University Press. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

  16. 42 CFR 416.171 - Determination of payment rates for ASC services.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... payment rates for office-based surgical procedures and covered ancillary radiology services... relative value units under § 414.22(b)(5)(i)(B) of this subchapter multiplied by the conversion factor... ancillary radiology services that involve certain nuclear medicine procedures will be the amount determined...

  17. 78 FR 79058 - Proposed Information Collection Request; Notice of New Requirements and Procedures for Grant...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-12-27

    ...The DOT invites the public and other Federal agencies to comment on a revision to a previously approved information collection concerning new requirements and procedures for grant payment request submission. DOT will submit the proposed renewal of information collection request to the Office of Management and Budget (OMB) for review, as required by the Paperwork Reduction Act of 1995 (PRA) (44 U.S.C. 3506 (c)(2)(A)). This notice sets forth new requirements and procedures for grantees that submit and receive payments from DOT Operating Administrations (OAs).\\1\\ DOT is updating systems that support grant payments and there will be changes to the way grantees complete and submit payment requests. Simplifying the DOT grant payment process will save both the grantee and the Federal Government time and expense that come with paper-based grant application and payment administration. Note: At this time, this requirement is not applicable to DOT grant recipients requesting payment electronically through the National Highway Traffic Safety Administration's Grant Tracking System (GTS), the Federal Highway Administration's Rapid Approval State Payment System (RASPS), or Federal Transit Administration (FTA) grant recipients requesting payment through the Electronic Clearing House Operation System (ECHO-Web). ---------------------------------------------------------------------------

  18. Reliability of hospital cost profiles in inpatient surgery.

    PubMed

    Grenda, Tyler R; Krell, Robert W; Dimick, Justin B

    2016-02-01

    With increased policy emphasis on shifting risk from payers to providers through mechanisms such as bundled payments and accountable care organizations, hospitals are increasingly in need of metrics to understand their costs relative to peers. However, it is unclear whether Medicare payments for surgery can reliably compare hospital costs. We used national Medicare data to assess patients undergoing colectomy, pancreatectomy, and open incisional hernia repair from 2009 to 2010 (n = 339,882 patients). We first calculated risk-adjusted hospital total episode payments for each procedure. We then used hierarchical modeling techniques to estimate the reliability of total episode payments for each procedure and explored the impact of hospital caseload on payment reliability. Finally, we quantified the number of hospitals meeting published reliability benchmarks. Mean risk-adjusted total episode payments ranged from $13,262 (standard deviation [SD] $14,523) for incisional hernia repair to $25,055 (SD $22,549) for pancreatectomy. The reliability of hospital episode payments varied widely across procedures and depended on sample size. For example, mean episode payment reliability for colectomy (mean caseload, 157) was 0.80 (SD 0.18), whereas for pancreatectomy (mean caseload, 13) the mean reliability was 0.45 (SD 0.27). Many hospitals met published reliability benchmarks for each procedure. For example, 90% of hospitals met reliability benchmarks for colectomy, 40% for pancreatectomy, and 66% for incisional hernia repair. Episode payments for inpatient surgery are a reliable measure of hospital costs for commonly performed procedures, but are less reliable for lower volume operations. These findings suggest that hospital cost profiles based on Medicare claims data may be used to benchmark efficiency, especially for more common procedures. Copyright © 2016 Elsevier Inc. All rights reserved.

  19. Financial impact to providers using pediatric combination vaccines.

    PubMed

    Shen, Angela K; Sobczyk, Elizabeth; Simonsen, Lone; Khan, Farid; Esber, Allahna; Andreae, Margie C

    2011-12-01

    To understand the financial impact to providers for using a combination vaccine (Pediarix [GlaxoSmithKline Biologicals, King of Prussia, PA]) versus its equivalent component vaccines for children aged 1 year or younger. Using a subscription remittance billing service offered to private-practice office-based physicians, we analyzed charge and payment information submitted by providers to insurance payers from June 2007 through July 2009. We analyzed provider and payer characteristics, payer comments, and the ratio of vaccine product to immunization administration (IA) codes and computed total charges and payments to providers for both arms of the study. Most providers in our data set were pediatricians (74%), and most payers were commercial (75%), primarily managed care. The ratio of the number of vaccine products to the number of IAs was 1:1 in the majority of the claims. Twenty percent of claims were paid with no adjustment by the payer, whereas 76% of the claims were adjusted for charges that exceeded the contract arrangement or the fee schedule. Providers received $23 less from commercial payers and $13 less from Medicaid for the use of Pediarix compared with the equivalent component vaccines. The mean commercial payment was greater for age-specific Current Procedural Terminology IA codes 90465 and 90466 than for non-age-specific codes 90471 and 90472, whereas the reverse was true for Medicaid. Providers who administer vaccines to children face a reduction in payment when choosing to provide combination vaccines. The new IA codes should be monitored for correction of financial barriers to the use of combination vaccines.

  20. Preparing for budget-based payment methodologies: global payment and episode-based payment.

    PubMed

    Hudson, Mark E

    2015-10-01

    Use of budget-based payment methodologies (capitation and episode-based bundled payment) has been demonstrated to drive value in healthcare delivery. With a focus on high-volume, high-cost surgical procedures, inclusion of anaesthesiology services in these methodologies is likely. This review provides a summary of budget-based payment methodologies and practical information necessary for anaesthesiologists to prepare for participation in these programmes. Although few examples of anaesthesiologists' participation in these models exist, an understanding of the structure of these programmes and opportunities for participation are available. Prospective preparation in developing anaesthesiology-specific bundled payment profiles and early participation in pathway development associated with selected episodes of care are essential for successful participation as a gainsharing partner. With significant opportunity to contribute to care coordination and cost management, anaesthesiology can play an important role in budget-based payment programmes and should expect to participate as full gainsharing partners. Precise costing methodologies and accurate economic modelling, along with identification of quality management and cost control opportunities, will help identify participation opportunities and appropriate payment and gainsharing agreements. Anaesthesiology-specific examples with budget-based payment models are needed to help guide increased participation in these programmes.

  1. Impact of payment system change from per-case to per-diem on high severity patient's length of stay.

    PubMed

    Jang, Sung-In; Nam, Chung Mo; Lee, Sang Gyu; Kim, Tae Hyun; Park, Sohee; Park, Eun-Cheol

    2016-09-01

    A new payment system, the diagnosis-related group (DRG) system, and Korean diagnosis procedure combination (KDPC, per-diem) payment system were officially introduced in 2002 and in 2012, respectively. We evaluated the impact of payment system change from per-case to per-diem on high severity patient's length of stay (LOS).Claim data was used. A total of 36,240 case admissions and 72,480 control admissions were included in the analysis. Segmented regression analysis of interrupted time series between cases and controls was conducted. Hospitals that consistently participated in the DRG payment system and changed to the KDPC payment system were defined as case hospitals. Hospitals that consistently participated in the DRG payment system were defined as control hospitals.LOS increased by 0.025 days per month (P = 0.0055) for 3 surgical diagnosis-related admissions due to the bundled payment system change. LOS among emergency admissions also increased and showed an increasing tendency under the KDPC. The LOS increase was observed specifically for complex procedure admissions and high severity cases (CCI 0, 1: 0.022, P = 0.0142; CCI 2, 3: 0.026, P = 0.0288; CCI ≥ 4: 0.055, P = 0.0003).Although both payment systems are optimized to decrease LOS, incentives to reduce LOS are stronger under the DRG system than under the KDPC system. It is worth noting that too strong incentive for reducing LOS is suitable to high severity cases.

  2. Remediation of negative side effects of an on-going response-cost system with chronic mental patients.

    PubMed

    Doty, D W; McInnis, T; Paul, G L

    1974-01-01

    Response-cost procedures within a token economy with extremely regressed residents excluded many residents from access to positive reinforcement. Procedures allowing residents to "purchase eligibility" to obtain backup reinforcers through contingent payment on standing fines, combined with proportional fine payoff schedules contingent upon time without new fines, increased payment on fines, reduced incidence of new fines, and increased utilization of backup reinforcers. These modifications removed adverse side effects while retaining the benefits associated with response costs. Failures or adverse effects of elements of token systems should not occasion abandonment of token economies, but rather encourage their continual evaluation and modification.

  3. The role of industry influence in sinus balloon dilation: Trends over time.

    PubMed

    Gadkaree, Shekhar K; Rathi, Vinay K; Gottschalk, Esther; Feng, Allen L; Phillips, Katie M; Scangas, George A; Metson, Ralph

    2018-05-08

    Balloon dilation (BD) is a controversial alternative to conventional sinus surgery. The role of industry on practice patterns remains unknown. The aim of this study was to determine whether industry payments from BD manufacturers influence practice patterns for otolaryngologists and evaluate how these payments change over time. Retrospective cohort study using Medicare Provider Utilization and Payment (PUP) Data and Center for Medicare and Medicaid Services Open Payments (OP) general payment datasets. A total of 294 otolaryngologists identified in the PUP dataset who performed BD procedures from January 1, 2013, to December 31, 2015, were cross-referenced in the OP dataset from January 1, 2014, to December 31, 2016, for BD manufacturer payments. Payments to surgeons performing BD stratified by amount, type, and number of procedures performed were primary outcome measures. Of the 294 otolaryngologists reporting BD procedures, 223 (76%) received payments from a company that manufactures BD devices. Receipt of $2,500 in BD payments was associated with performance of one additional BD procedure, and consulting fees were most positively associated with performing additional BD procedures (P = 0.006). The providers receiving the most in BD payments were more likely to continue to receive the most in payments, regardless of number of BD procedures performed. Performing more BD procedures did not correlate with decrease in other sinus procedures. Payments to otolaryngologists from manufacturers of sinus BD devices are associated with the performance of an increased number of such procedures. Surgeons should consider the impact of interactions with industry when evaluating patients for BD procedures. 4. Laryngoscope, 00:000-000, 2018. © 2018 The American Laryngological, Rhinological and Otological Society, Inc.

  4. 5 CFR 1315.6 - Payment without evidence that supplies have been received (fast payment).

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... have been received (fast payment). 1315.6 Section 1315.6 Administrative Personnel OFFICE OF MANAGEMENT... received (fast payment). (a) In limited situations, payment may be made without evidence that supplies have... “Fast Payment Procedure,” for use when using this fast payment procedure. ...

  5. 5 CFR 1315.6 - Payment without evidence that supplies have been received (fast payment).

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... have been received (fast payment). 1315.6 Section 1315.6 Administrative Personnel OFFICE OF MANAGEMENT... received (fast payment). (a) In limited situations, payment may be made without evidence that supplies have... “Fast Payment Procedure,” for use when using this fast payment procedure. ...

  6. 5 CFR 1315.6 - Payment without evidence that supplies have been received (fast payment).

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... have been received (fast payment). 1315.6 Section 1315.6 Administrative Personnel OFFICE OF MANAGEMENT... received (fast payment). (a) In limited situations, payment may be made without evidence that supplies have... “Fast Payment Procedure,” for use when using this fast payment procedure. ...

  7. 5 CFR 1315.6 - Payment without evidence that supplies have been received (fast payment).

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... have been received (fast payment). 1315.6 Section 1315.6 Administrative Personnel OFFICE OF MANAGEMENT... received (fast payment). (a) In limited situations, payment may be made without evidence that supplies have... “Fast Payment Procedure,” for use when using this fast payment procedure. ...

  8. 10 CFR 766.105 - Payment procedures.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 10 Energy 4 2012-01-01 2012-01-01 false Payment procedures. 766.105 Section 766.105 Energy DEPARTMENT OF ENERGY URANIUM ENRICHMENT DECONTAMINATION AND DECOMMISSIONING FUND; PROCEDURES FOR SPECIAL ASSESSMENT OF DOMESTIC UTILITIES Procedures for Special Assessment § 766.105 Payment procedures. DOE shall...

  9. 10 CFR 766.105 - Payment procedures.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 10 Energy 4 2011-01-01 2011-01-01 false Payment procedures. 766.105 Section 766.105 Energy DEPARTMENT OF ENERGY URANIUM ENRICHMENT DECONTAMINATION AND DECOMMISSIONING FUND; PROCEDURES FOR SPECIAL ASSESSMENT OF DOMESTIC UTILITIES Procedures for Special Assessment § 766.105 Payment procedures. DOE shall...

  10. 10 CFR 766.105 - Payment procedures.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 10 Energy 4 2014-01-01 2014-01-01 false Payment procedures. 766.105 Section 766.105 Energy DEPARTMENT OF ENERGY URANIUM ENRICHMENT DECONTAMINATION AND DECOMMISSIONING FUND; PROCEDURES FOR SPECIAL ASSESSMENT OF DOMESTIC UTILITIES Procedures for Special Assessment § 766.105 Payment procedures. DOE shall...

  11. 10 CFR 766.105 - Payment procedures.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 10 Energy 4 2010-01-01 2010-01-01 false Payment procedures. 766.105 Section 766.105 Energy DEPARTMENT OF ENERGY URANIUM ENRICHMENT DECONTAMINATION AND DECOMMISSIONING FUND; PROCEDURES FOR SPECIAL ASSESSMENT OF DOMESTIC UTILITIES Procedures for Special Assessment § 766.105 Payment procedures. DOE shall...

  12. 48 CFR 232.1004 - Procedure.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... OF DEFENSE GENERAL CONTRACTING REQUIREMENTS CONTRACT FINANCING Performance-Based Payments 232.1004 Procedure. (c) Instructions for multiple appropriations. If the contract contains foreign military sales...

  13. 48 CFR 232.1004 - Procedure.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... OF DEFENSE GENERAL CONTRACTING REQUIREMENTS CONTRACT FINANCING Performance-Based Payments 232.1004 Procedure. (c) Instructions for multiple appropriations. If the contract contains foreign military sales...

  14. 48 CFR 52.213-1 - Fast Payment Procedure.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 48 Federal Acquisition Regulations System 2 2012-10-01 2012-10-01 false Fast Payment Procedure. 52....213-1 Fast Payment Procedure. As prescribed in 13.404, insert the following clause: Fast Payment... contract, order, or blanket purchase agreement; and (ii) Display prominently on the invoice “FAST PAY...

  15. 48 CFR 52.213-1 - Fast Payment Procedure.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 48 Federal Acquisition Regulations System 2 2011-10-01 2011-10-01 false Fast Payment Procedure. 52....213-1 Fast Payment Procedure. As prescribed in 13.404, insert the following clause: Fast Payment... contract, order, or blanket purchase agreement; and (ii) Display prominently on the invoice “FAST PAY...

  16. 48 CFR 52.213-1 - Fast Payment Procedure.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 48 Federal Acquisition Regulations System 2 2014-10-01 2014-10-01 false Fast Payment Procedure. 52....213-1 Fast Payment Procedure. As prescribed in 13.404, insert the following clause: Fast Payment... contract, order, or blanket purchase agreement; and (ii) Display prominently on the invoice “FAST PAY...

  17. 48 CFR 52.213-1 - Fast Payment Procedure.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 48 Federal Acquisition Regulations System 2 2010-10-01 2010-10-01 false Fast Payment Procedure. 52....213-1 Fast Payment Procedure. As prescribed in 13.404, insert the following clause: Fast Payment... contract, order, or blanket purchase agreement; and (ii) Display prominently on the invoice “FAST PAY...

  18. 48 CFR 52.213-1 - Fast Payment Procedure.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 48 Federal Acquisition Regulations System 2 2013-10-01 2013-10-01 false Fast Payment Procedure. 52....213-1 Fast Payment Procedure. As prescribed in 13.404, insert the following clause: Fast Payment... contract, order, or blanket purchase agreement; and (ii) Display prominently on the invoice “FAST PAY...

  19. Value based care and bundled payments: Anesthesia care costs for outpatient oncology surgery using time-driven activity-based costing.

    PubMed

    French, Katy E; Guzman, Alexis B; Rubio, Augustin C; Frenzel, John C; Feeley, Thomas W

    2016-09-01

    With the movement towards bundled payments, stakeholders should know the true cost of the care they deliver. Time-driven activity-based costing (TDABC) can be used to estimate costs for each episode of care. In this analysis, TDABC is used to both estimate the costs of anesthesia care and identify the primary drivers of those costs of 11 common oncologic outpatient surgical procedures. Personnel cost were calculated by determining the hourly cost of each provider and the associated process time of the 11 surgical procedures. Using the anesthesia record, drugs, supplies and equipment costs were identified and calculated. The current staffing model was used to determine baseline personnel costs for each procedure. Using the costs identified through TDABC analysis, the effect of different staffing ratios on anesthesia costs could be predicted. Costs for each of the procedures were determined. Process time and costs are linearly related. Personnel represented 79% of overall cost while drugs, supplies and equipment represented the remaining 21%. Changing staffing ratios shows potential savings between 13% and 28% across the 11 procedures. TDABC can be used to estimate the costs of anesthesia care. This costing information is critical to assessing the anesthesiology component in a bundled payment. It can also be used to identify areas of cost savings and model costs of anesthesia care. CRNA to anesthesiologist staffing ratios profoundly influence the cost of care. This methodology could be applied to other medical specialties to help determine costs in the setting of bundled payments. Copyright © 2015 Elsevier Inc. All rights reserved.

  20. Value Based Care and Bundled Payments: Anesthesia Care Costs for Outpatient Oncology Surgery Using Time-Driven Activity-Based Costing

    PubMed Central

    French, Katy E.; Guzman, Alexis B.; Rubio, Augustin C.; Frenzel, John C.; Feeley, Thomas W

    2015-01-01

    Background With the movement towards bundled payments, stakeholders should know the true cost of the care they deliver. Time-driven activity-based costing (TDABC) can be used to estimate costs for each episode of care. In this analysis, TDABC is used to both estimate the costs of anesthesia care and identify the primary drivers of those costs of 11 common oncologic outpatient surgical procedures. Methods Personnel cost were calculated by determining the hourly cost of each provider and the associated process time of the 11 surgical procedures. Using the anesthesia record, drugs, supplies and equipment costs were identified and calculated. The current staffing model was used to determine baseline personnel costs for each procedure. Using the costs identified through TDABC analysis, the effect of different staffing ratios on anesthesia costs could be predicted. Results Costs for each of the procedures were determined. Process time and costs are linearly related. Personnel represented 79% of overall cost while drugs, supplies and equipment represented the remaining 21%. Changing staffing ratios shows potential savings between 13-28% across the 11 procedures. Conclusions TDABC can be used to estimate the costs of anesthesia care. This costing information is critical to assessing the anesthesiology component in a bundled payment. It can also be used to identify areas of cost savings and model costs of anesthesia care. CRNA to anesthesiologist staffing ratios profoundly influence the cost of care. This methodology could be applied to other medical specialties to help determine costs in the setting of bundled payments. PMID:27637823

  1. 48 CFR 32.007 - Contract financing payments.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... extent of contract financing arrangements are integrated with agency contract pricing policies. (4... otherwise prescribed in agency policies and procedures or otherwise specified in paragraph (b) of this... due date. (3) Agency heads may prescribe shorter periods for payment based on contract pricing or...

  2. 44 CFR 72.4 - Submittal/payment procedures and FEMA response.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 44 Emergency Management and Assistance 1 2010-10-01 2010-10-01 false Submittal/payment procedures and FEMA response. 72.4 Section 72.4 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT... PROCEDURES AND FEES FOR PROCESSING MAP CHANGES § 72.4 Submittal/payment procedures and FEMA response. (a) The...

  3. 44 CFR 72.4 - Submittal/payment procedures and FEMA response.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 44 Emergency Management and Assistance 1 2011-10-01 2011-10-01 false Submittal/payment procedures and FEMA response. 72.4 Section 72.4 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT... PROCEDURES AND FEES FOR PROCESSING MAP CHANGES § 72.4 Submittal/payment procedures and FEMA response. (a) The...

  4. 23 CFR 635.122 - Participation in progress payments.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... OPERATIONS CONSTRUCTION AND MAINTENANCE Contract Procedures § 635.122 Participation in progress payments. (a..., based on a request for reimbursement submitted by State transportation departments. When the contract... value of the stockpiled material shall not exceed the appropriate portion of the value of the contract...

  5. A Comparison of Ambulatory Surgery Center Production Costs and Medicare Payments: Evidence on Colonoscopy and Endoscopy.

    PubMed

    Mitchell, Jean M; Carey, Kathleen

    2016-02-01

    Ambulatory surgery centers (ASCs) are freestanding facilities that specialize in surgical and diagnostic procedures that do not require an overnight stay. While it is generally assumed that ASCs are less costly than hospital outpatient surgery departments, there is sparse empirical evidence regarding their relative production costs. To estimate ASC production costs using financial and claims records for procedures performed by surgery centers that specialize in gastroenterology procedures (colonoscopy and endoscopy). We estimate production costs in ASCs that specialize in gastroenterology procedures using financial cost and patient discharge data from Pennsylvania for the time period 2004-2013. We focus on the 2 primary procedures (colonoscopies and endoscopies) performed at each ASC. We use our estimates to predict average costs for each procedure and then compare predicted costs to Medicare ACS payments for these procedures. Comparisons of the costs of each procedure with 2013 national Medicare ASC payment rates suggest that Medicare payments exceed production costs for both colonoscopy and endoscopy. This study demonstrated that it is feasible to estimate production costs for procedures performed in freestanding surgery centers. The procedure-specific cost estimates can then be compared with ASC payment rates to ascertain if payments are aligned with costs. This approach can serve as an evaluation template for CMS and private insurers who are concerned that ASC facility payments for specific procedures may be excessive.

  6. Variation in Bariatric Surgery Episode Costs in the Commercially Insured: Implications for Bundled Payments in the Private Sector.

    PubMed

    Kelsall, Alexander C; Cassidy, Ruth; Ghaferi, Amir A

    2017-08-01

    To describe hospital-level variation in roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) in Michigan. Bariatric surgery is an increasingly prevalent elective surgical procedure that will likely be considered for future bundled payment programs, both public and private. Past research in the Medicare population found that the index hospitalization is responsible for the majority of payment variation among hospitals. However, this research largely excluded SG, now the most commonly performed bariatric surgery procedure nationally. We used data from a state-wide quality collaborative to calculate the average risk and price-adjusted 30-day episode payment for patients undergoing RYGB and SG procedures at Michigan hospitals between January 2009 and October 2014. We organized hospitals into quintiles and compared the variation in payments between highest and lowest-cost quintiles, and also the payment categories that drove this variation. We identified 9035 patients undergoing RYGB (n = 4194) or SG (n = 4841) procedures at 31 hospitals. The average price and risk-adjusted episode payment ranged from $11,874 in the lowest hospital quintile to $13,394 in the highest quintile, representing a difference of $1519 (12.8%). Payments for the index hospitalization accounted for the largest share of total episode costs for both procedure types. Despite representing 2.7% to 6.0% of payments across quintiles, postdischarge payments explained 22.6% of hospital variation in SG. Similarly, readmissions explained 24.5% of payment variation for SG episodes, despite representing between 1.2% and 4.4% of payments. Collectively, our findings suggest that there are previously underappreciated differences in episode payment variation between bariatric surgery procedures. SG may be more amenable to cost containment under bundled payment initiatives by virtue of the greater share of variation explained by readmission and postdischarge payments, components of episode payment more likely to be influenced by provider discretion.

  7. Measuring Provider Performance for Physicians Participating in the Merit-Based Incentive Payment System.

    PubMed

    Squitieri, Lee; Chung, Kevin C

    2017-07-01

    In 2017, the Centers for Medicare and Medicaid Services began requiring all eligible providers to participate in the Quality Payment Program or face financial reimbursement penalty. The Quality Payment Program outlines two paths for provider participation: the Merit-Based Incentive Payment System and Advanced Alternative Payment Models. For the first performance period beginning in January of 2017, the Centers for Medicare and Medicaid Services estimates that approximately 83 to 90 percent of eligible providers will not qualify for participation in an Advanced Alternative Payment Model and therefore must participate in the Merit-Based Incentive Payment System program. The Merit-Based Incentive Payment System path replaces existing quality-reporting programs and adds several new measures to evaluate providers using four categories of data: (1) quality, (2) cost/resource use, (3) improvement activities, and (4) advancing care information. These categories will be combined to calculate a weighted composite score for each provider or provider group. Composite Merit-Based Incentive Payment System scores based on 2017 performance data will be used to adjust reimbursed payment in 2019. In this article, the authors provide relevant background for understanding value-based provider performance measurement. The authors also discuss Merit-Based Incentive Payment System reporting requirements and scoring methodology to provide plastic surgeons with the necessary information to critically evaluate their own practice capabilities in the context of current performance metrics under the Quality Payment Program.

  8. 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...

  9. 48 CFR 13.402 - Conditions for use.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... AND CONTRACT TYPES SIMPLIFIED ACQUISITION PROCEDURES Fast Payment Procedure 13.402 Conditions for use. If the conditions in paragraphs (a) through (f) of this section are present, the fast payment... purchase. The conditions for use of the fast payment procedure are as follows: (a) Individual purchasing...

  10. 48 CFR 13.402 - Conditions for use.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... AND CONTRACT TYPES SIMPLIFIED ACQUISITION PROCEDURES Fast Payment Procedure 13.402 Conditions for use. If the conditions in paragraphs (a) through (f) of this section are present, the fast payment... purchase. The conditions for use of the fast payment procedure are as follows: (a) Individual purchasing...

  11. 48 CFR 13.402 - Conditions for use.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... AND CONTRACT TYPES SIMPLIFIED ACQUISITION PROCEDURES Fast Payment Procedure 13.402 Conditions for use. If the conditions in paragraphs (a) through (f) of this section are present, the fast payment... purchase. The conditions for use of the fast payment procedure are as follows: (a) Individual purchasing...

  12. 48 CFR 13.402 - Conditions for use.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... AND CONTRACT TYPES SIMPLIFIED ACQUISITION PROCEDURES Fast Payment Procedure 13.402 Conditions for use. If the conditions in paragraphs (a) through (f) of this section are present, the fast payment... purchase. The conditions for use of the fast payment procedure are as follows: (a) Individual purchasing...

  13. 48 CFR 13.404 - Contract clause.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... AND CONTRACT TYPES SIMPLIFIED ACQUISITION PROCEDURES Fast Payment Procedure 13.404 Contract clause. The contracting officer shall insert the clause at 52.213-1, Fast Payment Procedure, in solicitations and contracts when the conditions in 13.402 are applicable and it is intended that the fast payment...

  14. 48 CFR 13.404 - Contract clause.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... AND CONTRACT TYPES SIMPLIFIED ACQUISITION PROCEDURES Fast Payment Procedure 13.404 Contract clause. The contracting officer shall insert the clause at 52.213-1, Fast Payment Procedure, in solicitations and contracts when the conditions in 13.402 are applicable and it is intended that the fast payment...

  15. 48 CFR 13.404 - Contract clause.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... AND CONTRACT TYPES SIMPLIFIED ACQUISITION PROCEDURES Fast Payment Procedure 13.404 Contract clause. The contracting officer shall insert the clause at 52.213-1, Fast Payment Procedure, in solicitations and contracts when the conditions in 13.402 are applicable and it is intended that the fast payment...

  16. 48 CFR 13.402 - Conditions for use.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... AND CONTRACT TYPES SIMPLIFIED ACQUISITION PROCEDURES Fast Payment Procedure 13.402 Conditions for use. If the conditions in paragraphs (a) through (f) of this section are present, the fast payment... purchase. The conditions for use of the fast payment procedure are as follows: (a) Individual purchasing...

  17. 48 CFR 13.404 - Contract clause.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... AND CONTRACT TYPES SIMPLIFIED ACQUISITION PROCEDURES Fast Payment Procedure 13.404 Contract clause. The contracting officer shall insert the clause at 52.213-1, Fast Payment Procedure, in solicitations and contracts when the conditions in 13.402 are applicable and it is intended that the fast payment...

  18. 48 CFR 13.404 - Contract clause.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... AND CONTRACT TYPES SIMPLIFIED ACQUISITION PROCEDURES Fast Payment Procedure 13.404 Contract clause. The contracting officer shall insert the clause at 52.213-1, Fast Payment Procedure, in solicitations and contracts when the conditions in 13.402 are applicable and it is intended that the fast payment...

  19. 24 CFR 203.436 - Claim procedure-graduated payment mortgages.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 24 Housing and Urban Development 2 2011-04-01 2011-04-01 false Claim procedure-graduated payment... AUTHORITIES SINGLE FAMILY MORTGAGE INSURANCE Contract Rights and Obligations Graduated Payment Mortgages § 203.436 Claim procedure—graduated payment mortgages. All of the provisions of this subpart are applicable...

  20. 24 CFR 203.436 - Claim procedure-graduated payment mortgages.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 24 Housing and Urban Development 2 2010-04-01 2010-04-01 false Claim procedure-graduated payment... AUTHORITIES SINGLE FAMILY MORTGAGE INSURANCE Contract Rights and Obligations Graduated Payment Mortgages § 203.436 Claim procedure—graduated payment mortgages. All of the provisions of this subpart are applicable...

  1. 24 CFR 203.436 - Claim procedure-graduated payment mortgages.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 24 Housing and Urban Development 2 2014-04-01 2014-04-01 false Claim procedure-graduated payment... AUTHORITIES SINGLE FAMILY MORTGAGE INSURANCE Contract Rights and Obligations Graduated Payment Mortgages § 203.436 Claim procedure—graduated payment mortgages. All of the provisions of this subpart are applicable...

  2. 24 CFR 203.436 - Claim procedure-graduated payment mortgages.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 24 Housing and Urban Development 2 2012-04-01 2012-04-01 false Claim procedure-graduated payment... AUTHORITIES SINGLE FAMILY MORTGAGE INSURANCE Contract Rights and Obligations Graduated Payment Mortgages § 203.436 Claim procedure—graduated payment mortgages. All of the provisions of this subpart are applicable...

  3. 24 CFR 203.436 - Claim procedure-graduated payment mortgages.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 24 Housing and Urban Development 2 2013-04-01 2013-04-01 false Claim procedure-graduated payment... AUTHORITIES SINGLE FAMILY MORTGAGE INSURANCE Contract Rights and Obligations Graduated Payment Mortgages § 203.436 Claim procedure—graduated payment mortgages. All of the provisions of this subpart are applicable...

  4. Emerging lessons from regional and state innovation in value-based payment reform: balancing collaboration and disruptive innovation.

    PubMed

    Conrad, Douglas A; Grembowski, David; Hernandez, Susan E; Lau, Bernard; Marcus-Smith, Miriam

    2014-09-01

    In recent decades, practitioners and policymakers have turned to value-based payment initiatives to help contain spending on health care and to improve the quality of care. The Robert Wood Johnson Foundation funded 7 grantees across the country to design and implement value-based, multistakeholder payment reform projects in 6 states and 3 regions of the United States. As the external evaluator of these projects, we reviewed documents, conducted Internet searches, interviewed key stakeholders, cross-validated factual and narrative interpretation, and performed qualitative analyses to derive cross-site themes and implications for policy and practice. The nature of payment reform and its momentum closely reflects the environmental context of each project. Federal legislation such as the Patient Protection and Affordable Care Act and federal and state support for the development of the patient-centered medical home and accountable care organizations encourage value-based payment innovation, as do local market conditions for payers and providers that combine a history of collaboration with independent innovation and experimentation by individual organizations. Multistakeholder coalitions offer a useful facilitating structure for galvanizing payment reform. But to achieve the objectives of reduced cost and improved quality, multistakeholder payment innovation must overcome such barriers as incompatible information systems, the technical difficulties and transaction costs of altering existing billing and payment systems, competing stakeholder priorities, insufficient scale to bear population health risk, providers' limited experience with risk-bearing payment models, and the failure to align care delivery models with the form of payment. From the evidence adduced in this article, multistakeholder, value-based payment reform requires a trusted, widely respected "honest broker" that can convene and maintain the ongoing commitment of health plans, providers, and purchasers. Change management is complex and challenging, and coalition governance requires flexibility and stable leadership, as market conditions and stakeholder engagement and priorities shift over time. Another significant facilitator of value-based payment reform is outside investment that enables increased investment in human resources, information infrastructure, and care management by provider organizations and their collaborators. Supportive community and social service networks that enhance population health management also are important enablers of value-based payment reform. External pressure from public and private payers is fueling a "burning bridge" between the past of fee-for-service payment models and the future of payments based on value. Robust competition in local health plan and provider markets, coupled with an appropriate mix of multistakeholder governance, pressure from organized purchasers, and regulatory oversight, has the potential to spur value-based payment innovation that combines elements of "reformed" fee-for-service with bundled payments and global payments. © 2014 Milbank Memorial Fund.

  5. Lessons learned from the reimbursement profile of a mature private medical toxicology practice: office-based practice pays.

    PubMed

    Thompson, Trevonne M; Leikin, Jerrold B

    2015-03-01

    We previously reported the financial data for the first 5 years of one of the author's medical toxicology practice. The practice has matured; changes have been made. The practice is increasing its focus on office-based encounters and reducing hospital-based acute care encounters. We report the reimbursement rates and other financial metrics of the current practice. Financial records from October 2009 through September 2013 were reviewed. This is a period of 4 fiscal years and represents the currently available financial data. Charges, payments, and reimbursement rates were recorded according to the type and setting of the medical toxicology encounter: forensic consultations, outpatient clinic encounters, nonpsychiatric inpatient consultations, emergency department (ED) consultations, and inpatient psychiatric consultations. All patients were seen regardless of ability to pay or insurance status. The number of billed Current Procedural Terminology (CPT) codes for office-based encounters increased over the study period; the number of billed CPT codes for inpatient and ED consultations reduced. Office-based encounters demonstrate a higher reimbursement rate and higher payments. In the fiscal year (FY) of 2012, office-based revenue exceeded hospital-based acute care revenue by over $140,000 despite a higher number of billed CPT encounters in acute care settings, and outpatient payments were 2.39 times higher than inpatient, inpatient psychiatry, observation unit, and ED payments combined. The average payment per CPT code was higher for outpatient clinic encounters than inpatient encounters for each fiscal year studied. There was an overall reduction in CPT billing volume between FY 2010 and FY 2013. Despite this, there was an increase in total practice revenue. There was no change in payor mix, practice logistics, or billing/collection service company. In this medical toxicology practice, office-based encounters demonstrate higher reimbursement rates and overall payments compared to inpatient and ED consultations. While consistent with our previous studies, these differences have been accentuated. This study demonstrates the results of changes to the practice--reduced inpatient/ED consultations and increased outpatient encounters. These practice changes resulted in higher overall revenue despite a lower patient volume. In this analysis, the office-based practice of medical toxicology has higher reimbursement rates, nearly 2.5 times higher, when compared to hospital-based acute care consultations.

  6. 78 FR 31560 - Medicare Program; Public Meeting in Calendar Year 2013 for New Clinical Laboratory Test Payment...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-05-24

    ... announces a public meeting to receive comments and recommendations (including accompanying data on which recommendations are based) from the public on the appropriate basis for establishing payment amounts for new or substantially revised Healthcare Common Procedure Coding System (HCPCS) codes being considered for Medicare...

  7. Effect of Payment Model on Patient Outcomes in Outpatient Physical Therapy.

    PubMed

    Charles, Derek; Boyd, Sylvester; Heckert, Logan; Lake, Austin; Petersen, Kevin

    2018-01-01

    Although the literature has well recognized the effectiveness of physical therapy for treating musculoskeletal injuries, reimbursement is evolving towards value-based or alternative payment models and away from procedure orientated, fee-for-service in the outpatient setting. Alternative models include cased-based clinics, pay-for-performance, out-of-network services, accountable care organizations, and concierge practices. There is the possibility that alternative payment models could produce different and even superior patient outcomes. Physical therapists should be alert to this possibility, and research is warranted in this area to conclude if outcomes in patient care are related to method of reimbursement.

  8. 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.

  9. Medicare's "Global" terrorism: where is the pay for performance?

    PubMed

    Reed, R Lawrence; Luchette, Fred A; Esposito, Thomas J; Pyrz, Karen; Gamelli, Richard L

    2008-02-01

    Medicare and Medicaid Services (CMS) payment policies for surgical operations are based on a global package concept. CMS' physician fee schedule splits the global package into preoperative, intraoperative, and postoperative components of each procedure. We hypothesized that these global package component valuations were often lower than comparable evaluation and management (E&M) services and that billing for E&M services instead of the operation could often be more profitable. Our billing database and Trauma Registry were queried for the operative procedures and hospital lengths of stay for trauma patients during the past 5 years. Determinations of preoperative, intraoperative, and postoperative payments were calculated for 10-day and 90-day global packages, comparing them to CMS payments for comparable E&M codes. Of 90-day and 10-day Current Procedural Terminology codes, 88% and 100%, respectively, do not pay for the comprehensive history and physical that trauma patients usually receive, whereas 41% and 98%, respectively, do not even meet payment levels for a simple history and physical. Of 90-day global package procedures, 70% would have generated more revenue had comprehensive daily visits been billed instead of the operation ($3,057,500 vs. $1,658,058). For 10-day global package procedures, 56% would have generated more revenue with merely problem-focused daily visits instead of the operation ($161,855 vs. $156,318). Medicare's global surgical package underpays E&M services in trauma patients. In most cases, trauma surgeons would fare better by not billing for operations to receive higher reimbursement for E&M services that are considered "bundled" in the global package payment.

  10. 29 CFR 5.11 - Disputes concerning payment of wages.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 29 Labor 1 2010-07-01 2010-07-01 true Disputes concerning payment of wages. 5.11 Section 5.11... Provisions and Procedures § 5.11 Disputes concerning payment of wages. (a) This section sets forth the procedure for resolution of disputes of fact or law concerning payment of prevailing wage rates, overtime...

  11. 20 CFR 416.2097 - Combined supplementary/SSI payment levels.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false Combined supplementary/SSI payment levels... Combined supplementary/SSI payment levels. (a) Other than the level for residents of Medicaid facilities (see paragraph (d) of this section), the combined supplementary/SSI payment level for each payment...

  12. 78 FR 46955 - Animal Drug User Fee Rates and Payment Procedures for Fiscal Year 2014

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-08-02

    ...] Animal Drug User Fee Rates and Payment Procedures for Fiscal Year 2014 AGENCY: Food and Drug... payment procedures for fiscal year (FY) 2014 animal drug user fees. The Federal Food, Drug, and Cosmetic... submissions. This notice establishes the fee rates for FY 2014. FOR FURTHER INFORMATION CONTACT: Visit FDA's...

  13. Impact of Medicare payment reductions on access to surgical services.

    PubMed Central

    Mitchell, J B; Cromwell, J

    1995-01-01

    OBJECTIVE. This study evaluates the impact of surgical fee reductions under Medicare on the utilization of surgical services. DATA SOURCES. Medicare physician claims data were obtained from 11 states for a five-year time period (1985-1989). STUDY DESIGN. Under OBRA-87, Medicare reduced payments for 11 surgical procedures. A fixed effects regression method was used to determine the impact of these payment reductions on access to care for potentially vulnerable Medicare beneficiaries: joint Medicaid-eligibles, blacks, and the very old. DATA COLLECTION/EXTRACTION METHODS. Medicare claims and enrollment data were used to construct a cross-section time-series of population-based surgical rates from 1985 through 1989. PRINCIPAL FINDINGS. Reductions in surgical fees led to small but significant increases in use for three procedures, small decreases in use for two procedures, and no impact on the remaining six procedures. There was little evidence that access to surgery was impaired for potentially vulnerable enrollees; in fact, declining fees often led to greater rates of increases for some subgroups. CONCLUSIONS. Our results suggest that volume responses by surgeons to payment changes under the Medicare Fee Schedule may be smaller than HCFA's original estimates. Nevertheless, both access and quality of care should continue to be closely monitored. PMID:8537224

  14. 75 FR 45699 - Medicare Program: Changes to the Hospital Outpatient Prospective Payment System and CY 2010...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-08-03

    ... part of the office-based and ancillary radiology payment methodology. This notice updates the CY 2010... covered ancillary radiology services to the lesser of the ASC rate or the amount calculated by multiplying... procedures and covered ancillary radiology services are determined using the amounts in the MPFS final rule...

  15. Emerging Lessons From Regional and State Innovation in Value-Based Payment Reform: Balancing Collaboration and Disruptive Innovation

    PubMed Central

    Conrad, Douglas A; Grembowski, David; Hernandez, Susan E; Lau, Bernard; Marcus-Smith, Miriam

    2014-01-01

    Policy Points: Public and private purchasersmust create a "burning bridge" of countervailing pressure that signals "no turning back" to fee-for-service in order to sustain the momentum for value-based payment. Multi-stakeholder coalitions must establish a defined set of quality, outcomes, and cost performance measures and the interoperable information systems to support data collection and reporting of value-based payment schemes. Anti-trust vigilance is necessary to find the "sweet spot" of competition and cooperation among health plans and health care providers. Provider and health plan transparency of price and quality, supported by all-payer claims data, are critical in driving value-based payment innovation and cost constraint. Context In recent decades, practitioners and policymakers have turned to value-based payment initiatives to help contain spending on health care and to improve the quality of care. The Robert Wood Johnson Foundation funded 7 grantees across the country to design and implement value-based, multistakeholder payment reform projects in 6 states and 3 regions of the United States. Methods As the external evaluator of these projects, we reviewed documents, conducted Internet searches, interviewed key stakeholders, cross-validated factual and narrative interpretation, and performed qualitative analyses to derive cross-site themes and implications for policy and practice. Findings The nature of payment reform and its momentum closely reflects the environmental context of each project. Federal legislation such as the Patient Protection and Affordable Care Act and federal and state support for the development of the patient-centered medical home and accountable care organizations encourage value-based payment innovation, as do local market conditions for payers and providers that combine a history of collaboration with independent innovation and experimentation by individual organizations. Multistakeholder coalitions offer a useful facilitating structure for galvanizing payment reform. But to achieve the objectives of reduced cost and improved quality, multistakeholder payment innovation must overcome such barriers as incompatible information systems, the technical difficulties and transaction costs of altering existing billing and payment systems, competing stakeholder priorities, insufficient scale to bear population health risk, providers’ limited experience with risk-bearing payment models, and the failure to align care delivery models with the form of payment. Conclusions From the evidence adduced in this article, multistakeholder, value-based payment reform requires a trusted, widely respected “honest broker” that can convene and maintain the ongoing commitment of health plans, providers, and purchasers. Change management is complex and challenging, and coalition governance requires flexibility and stable leadership, as market conditions and stakeholder engagement and priorities shift over time. Another significant facilitator of value-based payment reform is outside investment that enables increased investment in human resources, information infrastructure, and care management by provider organizations and their collaborators. Supportive community and social service networks that enhance population health management also are important enablers of value-based payment reform. External pressure from public and private payers is fueling a “burning bridge” between the past of fee-for-service payment models and the future of payments based on value. Robust competition in local health plan and provider markets, coupled with an appropriate mix of multistakeholder governance, pressure from organized purchasers, and regulatory oversight, has the potential to spur value-based payment innovation that combines elements of “reformed” fee-for-service with bundled payments and global payments. PMID:25199900

  16. Why and how did Israel adopt activity-based hospital payment? The Procedure-Related Group incremental reform.

    PubMed

    Brammli-Greenberg, Shuli; Waitzberg, Ruth; Perman, Vadim; Gamzu, Ronni

    2016-10-01

    Historically, Israel paid its non-profit hospitals on a perdiem (PD) basis. Recently, like other OECD countries, Israel has moved to activity-based payments. While most countries have adopted a diagnostic related group (DRG) payment system, Israel has chosen a Procedure-Related Group (PRG) system. This differs from the DRG system because it classifies patients by procedure rather than diagnosis. In Israel, the PRG system was found to be more feasible given the lack of data and information needed in the DRG classification system. The Ministry of Health (MoH) chose a payment scheme that depends only on inhouse creation of PRG codes and costing, thus avoiding dependence on hospital data. The PRG tariffs are priced by a joint Health and Finance Ministry commission and updated periodically. Moreover, PRGs are believed to achieve the same main efficiency objectives as DRGs: increasing the volume of activity, shortening unnecessary hospitalization days, and reducing the gaps between the costs and prices of activities. The PRG system is being adopted through an incremental reform that started in 2002 and was accelerated in 2010. The Israeli MoH involved the main players in the hospital market in the consolidation of this potentially controversial reform in order to avoid opposition. The reform was implemented incrementally in order to preserve the balance of resource allocation and overall expenditures of the system, thus becoming budget neutral. Yet, as long as gaps remain between marginal costs and prices of procedures, PRGs will not attain all their objectives. Moreover, it is still crucial to refine PRG rates to reflect the severity of cases, in order to tackle incentives for selection of patients within each procedure. Copyright © 2016 The Author(s). Published by Elsevier Ireland Ltd.. All rights reserved.

  17. 23 CFR 190.1 - Purpose.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 23 Highways 1 2014-04-01 2014-04-01 false Purpose. 190.1 Section 190.1 Highways FEDERAL HIGHWAY ADMINISTRATION, DEPARTMENT OF TRANSPORTATION PAYMENT PROCEDURES INCENTIVE PAYMENTS FOR CONTROLLING OUTDOOR... procedures for making the incentive payments authorized by 23 U.S.C. 131(j). ...

  18. 23 CFR 190.1 - Purpose.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 23 Highways 1 2013-04-01 2013-04-01 false Purpose. 190.1 Section 190.1 Highways FEDERAL HIGHWAY ADMINISTRATION, DEPARTMENT OF TRANSPORTATION PAYMENT PROCEDURES INCENTIVE PAYMENTS FOR CONTROLLING OUTDOOR... procedures for making the incentive payments authorized by 23 U.S.C. 131(j). ...

  19. 23 CFR 190.1 - Purpose.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 23 Highways 1 2011-04-01 2011-04-01 false Purpose. 190.1 Section 190.1 Highways FEDERAL HIGHWAY ADMINISTRATION, DEPARTMENT OF TRANSPORTATION PAYMENT PROCEDURES INCENTIVE PAYMENTS FOR CONTROLLING OUTDOOR... procedures for making the incentive payments authorized by 23 U.S.C. 131(j). ...

  20. 23 CFR 190.1 - Purpose.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 23 Highways 1 2010-04-01 2010-04-01 false Purpose. 190.1 Section 190.1 Highways FEDERAL HIGHWAY ADMINISTRATION, DEPARTMENT OF TRANSPORTATION PAYMENT PROCEDURES INCENTIVE PAYMENTS FOR CONTROLLING OUTDOOR... procedures for making the incentive payments authorized by 23 U.S.C. 131(j). ...

  1. [Diagnosis-related groups as an instrument to develop suitable case-based lump sums in hematology and oncology].

    PubMed

    Thalheimer, Markus

    2011-01-01

    In 2003 a new reimbursement system was established for German hospitals. The approximately 17 million inpatient cases per year are now reimbursed based on a per-case payment regarding diagnoses and procedures, which was developed from an internationally approved system. The aim was a better conformity of costs and efforts in in-patient cases. In the first 2 years after implementation, the German diagnosis-related group (DRG) system was not able to adequately represent the complex structures of treatment in hematological and oncological in-patients. By creating new diagnoses and procedures (International Classification of Diseases 10 (ICD-10) and Surgical Operations and Procedures Classification System (OPS) catalogues), generating new DRGs and better splitting of existing ones, the hematology and oncology field could be much better described in the following years. The implementation of about 70 'co-payment structures' for new and expensive drugs and procedures in oncology was also crucial. To reimburse innovations, an additional system of co-payments for innovations was established to bridge the time until innovations are represented within the DRG system itself. In summary, hematological and oncological in-patients, including cases with extraordinary costs, are meanwhile well mapped in the German reimbursement system. Any tendencies to rationing could thereby be avoided, as most of the established procedures and costly drugs are adequately represented in the DRG system. Copyright © 2011 S. Karger AG, Basel.

  2. 78 FR 46958 - Animal Generic Drug User Fee Rates and Payment Procedures for Fiscal Year 2014

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-08-02

    ...] Animal Generic Drug User Fee Rates and Payment Procedures for Fiscal Year 2014 AGENCY: Food and Drug... and payment procedures for fiscal year (FY) 2014 generic new animal drug user fees. The Federal Food... for FY 2014. FOR FURTHER INFORMATION CONTACT: Visit FDA's Web site at http://www.fda.gov/ForIndustry...

  3. 48 CFR 13.403 - Preparation and execution of orders.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... REGULATION CONTRACTING METHODS AND CONTRACT TYPES SIMPLIFIED ACQUISITION PROCEDURES Fast Payment Procedure 13... the fast payment procedure shall include the following: (a) A requirement that the supplies be shipped...

  4. 48 CFR 13.403 - Preparation and execution of orders.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... REGULATION CONTRACTING METHODS AND CONTRACT TYPES SIMPLIFIED ACQUISITION PROCEDURES Fast Payment Procedure 13... the fast payment procedure shall include the following: (a) A requirement that the supplies be shipped...

  5. 48 CFR 13.403 - Preparation and execution of orders.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... REGULATION CONTRACTING METHODS AND CONTRACT TYPES SIMPLIFIED ACQUISITION PROCEDURES Fast Payment Procedure 13... the fast payment procedure shall include the following: (a) A requirement that the supplies be shipped...

  6. 48 CFR 13.403 - Preparation and execution of orders.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... REGULATION CONTRACTING METHODS AND CONTRACT TYPES SIMPLIFIED ACQUISITION PROCEDURES Fast Payment Procedure 13... the fast payment procedure shall include the following: (a) A requirement that the supplies be shipped...

  7. 48 CFR 13.403 - Preparation and execution of orders.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... REGULATION CONTRACTING METHODS AND CONTRACT TYPES SIMPLIFIED ACQUISITION PROCEDURES Fast Payment Procedure 13... the fast payment procedure shall include the following: (a) A requirement that the supplies be shipped...

  8. Access to Care Under Physician Payment Reform: A Physician-Based Analysis

    PubMed Central

    Meadow, Ann

    1995-01-01

    This article reports physician-based measures of access to care during the 3 years surrounding the 1989 physician payment reforms. Analysis was facilitated by a new system of physician identifiers in Medicare claims. Access measures include caseload per physician and related measures of the demographic composition of physicians' clientele, the proportion of physicians performing surgical and other procedures, and the assignment rate. The caseload and assignment measures were stable or improving over time, suggesting that reforms did not harm access. Procedure performance rates tended to decline between 1992 and 1993, but reductions were inversely related to the estimated fee changes, and several may be explainable by other factors. PMID:10172615

  9. 48 CFR 32.1004 - Procedures.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 48 Federal Acquisition Regulations System 1 2010-10-01 2010-10-01 false Procedures. 32.1004 Section 32.1004 Federal Acquisition Regulations System FEDERAL ACQUISITION REGULATION GENERAL CONTRACTING... performance-based payments are contract financing, events or criteria shall not serve as a vehicle to reward...

  10. Prospective Bundled Payments in a Changing Environment: The Experience of a Self-Funded, State-Sponsored Plan.

    PubMed

    Lawler, Frank H; Wilson, Frank R; Smith, G Keith; Mitchell, Lynn V

    2017-12-01

    Healthcare reimbursement, which has traditionally been based on the quantity of services delivered, is currently moving toward value-based reimbursement-a system that addresses the quantity, quality, and cost of services. One such arrangement has been the evolution of bundled payments for a specific procedure or for an episode of care, paid prospectively or through post-hoc reconciliation. To evaluate the impact of instituting bundled payments that incorporate facility charges, physician fees, and all ancillary charges by the State of Oklahoma HealthChoice public employee insurance plan. From January 1 through December 31, 2016, HealthChoice, a large, government-sponsored Oklahoma health plan, implemented a voluntary, prospective, bundled payment system with network facilities, called Select. The Select program allows members at the time of certification of the services to opt to use participating facilities for specified services at a bundled rate, with deductible and coinsurance covered by the health plan. That is, the program allows any plan member to choose either a participating Select facility with no out-of-pocket costs or standard benefits at a participating network facility. During 2016, more than 7900 procedures were performed for 5907 patients who chose the Select arrangement (also designated as the intervention group). The most common outpatient Select procedures were for cardiology, colonoscopy, and magnetic resonance imaging scans. The most common inpatient procedures for Select-covered patients were in 6 diagnosis-related groups covering spinal fusions, joint replacement surgeries, and percutaneous coronary artery stenting. The allowable costs were similar for bundled procedures at ambulatory surgery centers and at outpatient hospital facilities; the allowable costs for patients not in the Select program (mean, $813) were lower at ambulatory surgery centers than at outpatient hospital departments (mean, $3086) because of differences in case mix. Patients in the Select system who had outpatient procedures had significantly fewer subsequent claims than those who were not in Select for hospitalization (1.7% vs 2.5%, respectively) and emergency department visits (4.4% vs 11.5%, respectively) in the 30 days postprocedure. Quality measures (eg, wound infection and reoperation) were similar for patients who were and were not in the Select group and had procedures. Surgical complication (ie, return to surgery) rates were higher for the Select group. The Select program demonstrated promising results during its first year of operation, suggesting that prospective bundled payment arrangements can be implemented successfully. Further research on reimbursement mechanisms, that is, how to pay physicians and facilities, and quality of outcomes is needed, especially with respect to which procedures are most suitable for this payment arrangement.

  11. Prospective Bundled Payments in a Changing Environment: The Experience of a Self-Funded, State-Sponsored Plan

    PubMed Central

    Lawler, Frank H.; Wilson, Frank R.; Smith, G. Keith; Mitchell, Lynn V.

    2017-01-01

    Background Healthcare reimbursement, which has traditionally been based on the quantity of services delivered, is currently moving toward value-based reimbursement—a system that addresses the quantity, quality, and cost of services. One such arrangement has been the evolution of bundled payments for a specific procedure or for an episode of care, paid prospectively or through post-hoc reconciliation. Objective To evaluate the impact of instituting bundled payments that incorporate facility charges, physician fees, and all ancillary charges by the State of Oklahoma HealthChoice public employee insurance plan. Method From January 1 through December 31, 2016, HealthChoice, a large, government-sponsored Oklahoma health plan, implemented a voluntary, prospective, bundled payment system with network facilities, called Select. The Select program allows members at the time of certification of the services to opt to use participating facilities for specified services at a bundled rate, with deductible and coinsurance covered by the health plan. That is, the program allows any plan member to choose either a participating Select facility with no out-of-pocket costs or standard benefits at a participating network facility. Results During 2016, more than 7900 procedures were performed for 5907 patients who chose the Select arrangement (also designated as the intervention group). The most common outpatient Select procedures were for cardiology, colonoscopy, and magnetic resonance imaging scans. The most common inpatient procedures for Select-covered patients were in 6 diagnosis-related groups covering spinal fusions, joint replacement surgeries, and percutaneous coronary artery stenting. The allowable costs were similar for bundled procedures at ambulatory surgery centers and at outpatient hospital facilities; the allowable costs for patients not in the Select program (mean, $813) were lower at ambulatory surgery centers than at outpatient hospital departments (mean, $3086) because of differences in case mix. Patients in the Select system who had outpatient procedures had significantly fewer subsequent claims than those who were not in Select for hospitalization (1.7% vs 2.5%, respectively) and emergency department visits (4.4% vs 11.5%, respectively) in the 30 days postprocedure. Quality measures (eg, wound infection and reoperation) were similar for patients who were and were not in the Select group and had procedures. Surgical complication (ie, return to surgery) rates were higher for the Select group. Conclusion The Select program demonstrated promising results during its first year of operation, suggesting that prospective bundled payment arrangements can be implemented successfully. Further research on reimbursement mechanisms, that is, how to pay physicians and facilities, and quality of outcomes is needed, especially with respect to which procedures are most suitable for this payment arrangement. PMID:29403570

  12. 10 CFR 766.106 - Late payment fees.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 10 Energy 4 2014-01-01 2014-01-01 false Late payment fees. 766.106 Section 766.106 Energy DEPARTMENT OF ENERGY URANIUM ENRICHMENT DECONTAMINATION AND DECOMMISSIONING FUND; PROCEDURES FOR SPECIAL ASSESSMENT OF DOMESTIC UTILITIES Procedures for Special Assessment § 766.106 Late payment fees. In the case...

  13. 10 CFR 766.106 - Late payment fees.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 10 Energy 4 2011-01-01 2011-01-01 false Late payment fees. 766.106 Section 766.106 Energy DEPARTMENT OF ENERGY URANIUM ENRICHMENT DECONTAMINATION AND DECOMMISSIONING FUND; PROCEDURES FOR SPECIAL ASSESSMENT OF DOMESTIC UTILITIES Procedures for Special Assessment § 766.106 Late payment fees. In the case...

  14. 10 CFR 766.106 - Late payment fees.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 10 Energy 4 2012-01-01 2012-01-01 false Late payment fees. 766.106 Section 766.106 Energy DEPARTMENT OF ENERGY URANIUM ENRICHMENT DECONTAMINATION AND DECOMMISSIONING FUND; PROCEDURES FOR SPECIAL ASSESSMENT OF DOMESTIC UTILITIES Procedures for Special Assessment § 766.106 Late payment fees. In the case...

  15. 14 CFR 14.30 - Payment of award.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 14 Aeronautics and Space 1 2014-01-01 2014-01-01 false Payment of award. 14.30 Section 14.30 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION PROCEDURAL RULES RULES IMPLEMENTING THE EQUAL ACCESS TO JUSTICE ACT OF 1980 Procedures for Considering Applications § 14.30 Payment of...

  16. 14 CFR 14.30 - Payment of award.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 14 Aeronautics and Space 1 2012-01-01 2012-01-01 false Payment of award. 14.30 Section 14.30 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION PROCEDURAL RULES RULES IMPLEMENTING THE EQUAL ACCESS TO JUSTICE ACT OF 1980 Procedures for Considering Applications § 14.30 Payment of...

  17. 14 CFR 14.30 - Payment of award.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 14 Aeronautics and Space 1 2011-01-01 2011-01-01 false Payment of award. 14.30 Section 14.30 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION PROCEDURAL RULES RULES IMPLEMENTING THE EQUAL ACCESS TO JUSTICE ACT OF 1980 Procedures for Considering Applications § 14.30 Payment of...

  18. 14 CFR 14.30 - Payment of award.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 14 Aeronautics and Space 1 2010-01-01 2010-01-01 false Payment of award. 14.30 Section 14.30 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION PROCEDURAL RULES RULES IMPLEMENTING THE EQUAL ACCESS TO JUSTICE ACT OF 1980 Procedures for Considering Applications § 14.30 Payment of...

  19. 14 CFR 14.30 - Payment of award.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 14 Aeronautics and Space 1 2013-01-01 2013-01-01 false Payment of award. 14.30 Section 14.30 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION PROCEDURAL RULES RULES IMPLEMENTING THE EQUAL ACCESS TO JUSTICE ACT OF 1980 Procedures for Considering Applications § 14.30 Payment of...

  20. 24 CFR 234.259 - Claim procedure-graduated payment mortgages.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 24 Housing and Urban Development 2 2013-04-01 2013-04-01 false Claim procedure-graduated payment mortgages. 234.259 Section 234.259 Housing and Urban Development Regulations Relating to Housing and Urban... § 234.259 Claim procedure—graduated payment mortgages. Section 203.436 of this chapter applies to...

  1. 24 CFR 234.259 - Claim procedure-graduated payment mortgages.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 24 Housing and Urban Development 2 2011-04-01 2011-04-01 false Claim procedure-graduated payment mortgages. 234.259 Section 234.259 Housing and Urban Development Regulations Relating to Housing and Urban... § 234.259 Claim procedure—graduated payment mortgages. Section 203.436 of this chapter applies to...

  2. 24 CFR 234.259 - Claim procedure-graduated payment mortgages.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 24 Housing and Urban Development 2 2010-04-01 2010-04-01 false Claim procedure-graduated payment mortgages. 234.259 Section 234.259 Housing and Urban Development Regulations Relating to Housing and Urban... § 234.259 Claim procedure—graduated payment mortgages. Section 203.436 of this chapter applies to...

  3. 24 CFR 234.259 - Claim procedure-graduated payment mortgages.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 24 Housing and Urban Development 2 2012-04-01 2012-04-01 false Claim procedure-graduated payment mortgages. 234.259 Section 234.259 Housing and Urban Development Regulations Relating to Housing and Urban... § 234.259 Claim procedure—graduated payment mortgages. Section 203.436 of this chapter applies to...

  4. 24 CFR 234.259 - Claim procedure-graduated payment mortgages.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 24 Housing and Urban Development 2 2014-04-01 2014-04-01 false Claim procedure-graduated payment mortgages. 234.259 Section 234.259 Housing and Urban Development Regulations Relating to Housing and Urban... § 234.259 Claim procedure—graduated payment mortgages. Section 203.436 of this chapter applies to...

  5. 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...

  6. 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...

  7. 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...

  8. 75 FR 78707 - Medicare Program; First Semi-Annual Meeting of the Advisory Panel on Ambulatory Payment...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-12-16

    ... hospital payment systems; hospital medical care delivery systems; provider billing and accounting systems; APC groups; Current Procedural Terminology codes; Health Care Common Procedure Coding System (HCPCS) codes; the use of, and payment for, drugs, medical devices, and other services in the outpatient setting...

  9. Malpractice in otology.

    PubMed

    Blake, Danielle M; Svider, Peter F; Carniol, Eric T; Mauro, Andrew C; Eloy, Jean Anderson; Jyung, Robert W

    2013-10-01

    (1) Analyze otologic procedural malpractice litigation in the United States of America. (2) Discuss ways to prevent future malpractice litigation. Case series with record review. The study is a case series with review of court records pertaining to otologic procedures using the Westlaw legal database. The phrase medical malpractice was searched with terms related to otology and neurotology obtained from the AAO-HNS website. Of the 47 claims that met inclusion criteria, 63.8% were decided in the physician's favor, 25.5% were decided in the plaintiff's favor (average payment $446,697), and 10.6% were settled out of court (average payment $372,607). Cerumen removal was the most common procedure leading to complaint (21.3%) and the most likely procedure to lead to payment (50.0%). Hearing loss was the most common injury claimed among all cases (53.2%) and resulted in a high proportion of cases that led to payment (40.0%). Other common alleged injuries were facial nerve injury (27.7%), tympanic membrane perforation (23.4%), need for additional surgery (42.6%), and lack of informed consent (31.9%). In addition, cases resulting from acoustic neuroma or stapedectomy resulted in higher payments to the plaintiffs (average $3,498,597 and $2,733,000, respectively). Malpractice trials were resolved in the defendant's favor in the majority of cases. Cerumen removal was the most common procedure leading to complaint and the procedure most likely to result in payment. Hearing loss was the most common injury cited. Payment was highest in acoustic neuroma and stapedectomy cases.

  10. Did case-based payment influence surgical readmission rates in France? A retrospective study

    PubMed Central

    Vuagnat, Albert; Yilmaz, Engin; Roussot, Adrien; Rodwin, Victor; Gadreau, Maryse; Bernard, Alain; Creuzot-Garcher, Catherine; Quantin, Catherine

    2018-01-01

    Objectives To determine whether implementation of a case-based payment system changed all-cause readmission rates in the 30 days following discharge after surgery, we analysed all surgical procedures performed in all hospitals in France before (2002–2004), during (2005–2008) and after (2009–2012) its implementation. Setting Our study is based on claims data for all surgical procedures performed in all acute care hospitals with >300 surgical admissions per year (740 hospitals) in France over 11 years (2002–2012; n=51.6 million admissions). Interventions We analysed all-cause 30-day readmission rates after surgery using a logistic regression model and an interrupted time series analysis. Results The overall 30-day all-cause readmission rate following discharge after surgery increased from 8.8% to 10.0% (P<0.001) for the public sector and from 5.9% to 8.6% (P<0.001) for the private sector. Interrupted time series models revealed a significant linear increase in readmission rates over the study period in all types of hospitals. However, the implementation of case-based payment was only associated with a significant increase in rehospitalisation rates for private hospitals (P<0.001). Conclusion In France, the increase in the readmission rate appears to be relatively steady in both the private and public sector but appears not to have been affected by the introduction of a case-based payment system after accounting for changes in care practices in the public sector. PMID:29391376

  11. Association of Reference Payment for Colonoscopy With Consumer Choices, Insurer Spending, and Procedural Complications.

    PubMed

    Robinson, James C; Brown, Timothy T; Whaley, Christopher; Finlayson, Emily

    2015-11-01

    Regulatory limits on consumer cost sharing permit wide variation in the prices charged for screening and diagnostic tests such as colonoscopy. Employers are experimenting with reference payment initiatives that offer full insurance coverage at low-priced facilities but require substantial cost sharing if patients select high-priced alternatives. To ascertain the effect of reference payment on facility choice, insurer spending, consumer cost sharing, and procedural complications for colonoscopy. The California Public Employees' Retirement System (CalPERS) implemented reference payment in January 2012. We obtained data on 21 644 CalPERS enrollees who underwent colonoscopy in the 3 years prior to implementation and on 13 551 patients in the 2 years after implementation. Control group data were obtained on 258 616 Anthem Blue Cross enrollees who underwent colonoscopy and who were not subject to reference payment initiatives during this 5-year period. Consumer choice of facility, price paid per procedure, total insurer spending, consumer cost sharing, and procedural complications. Choices, prices, and complications were compared for CalPERS and Anthem patients before and after implementation of reference payments, using difference-in-difference multivariable regressions to adjust for patient demographic characteristics and comorbidities, procedure indications, and geographic location. Utilization of low-priced facilities for CalPERS members increased from 68.6% in 2009 to 90.5% in 2013. After adjusting for patient demographic characteristics, comorbidities, and other factors, the implementation of reference payment increased use of low-priced facilities by 17.6 percentage points (95% CI, 11.8 to 23.4; P < .001). The mean price paid for colonoscopy for the CalPERS population increased from $1587 (95% CI, $1555-$1618) in 2009 to $1716 (95% CI, $1678-$1753) in 2011 and then decreased to $1508 (95% CI, $1469-$1548) in 2013 for patients subject to reference payment. After adjustment for other relevant factors, reference payment was responsible for a 21.0% (95% CI, -26.0% to -15.6%, P < .001) reduction in the price. Reference payment was associated with a small but statistically insignificant decline in procedural complications, from 2.1% in 2009 to 2.0% in 2013 (P = .47). In the first 2 years after implementation, CalPERS saved $7.0 million (28%) on spending for the procedure. Implementation of reference payment for colonoscopy was associated with reduced spending and no change in complications.

  12. 42 CFR 414.506 - Procedures for public consultation for payment for a new clinical diagnostic laboratory test.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... a new clinical diagnostic laboratory test. 414.506 Section 414.506 Public Health CENTERS FOR... FOR PART B MEDICAL AND OTHER HEALTH SERVICES Payment for New Clinical Diagnostic Laboratory Tests § 414.506 Procedures for public consultation for payment for a new clinical diagnostic laboratory test...

  13. 26 CFR 301.6155-1 - Payment on notice and demand.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ...) PROCEDURE AND ADMINISTRATION PROCEDURE AND ADMINISTRATION Time and Place for Paying Tax Place and Due Date for Payment of Tax § 301.6155-1 Payment on notice and demand. Upon receipt of notice and demand from the district director (including the Director of International Operations) or the director of the...

  14. 42 CFR 414.506 - Procedures for public consultation for payment for a new clinical diagnostic laboratory test.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... a new clinical diagnostic laboratory test. 414.506 Section 414.506 Public Health CENTERS FOR... FOR PART B MEDICAL AND OTHER HEALTH SERVICES Payment for New Clinical Diagnostic Laboratory Tests § 414.506 Procedures for public consultation for payment for a new clinical diagnostic laboratory test...

  15. 31 CFR 370.14 - Can substitute payment procedures be used?

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 31 Money and Finance: Treasury 2 2010-07-01 2010-07-01 false Can substitute payment procedures be used? 370.14 Section 370.14 Money and Finance: Treasury Regulations Relating to Money and Finance... FUNDS TRANSFERS RELATING TO UNITED STATES SECURITIES Credit ACH Entries § 370.14 Can substitute payment...

  16. 76 FR 70209 - Proposed Information Collection Request; Notice of New Requirements and Procedures for Grant...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-11-10

    ... Procedures for Grant Payment Request Submission. OMB Control Number: XXXX-XXXX. Type of Request: New... Administrations (OAs).\\1\\ DOT is updating systems that support grant payments and there will be changes to the way... requesting payment electronically through the National Highway Traffic Safety Administration's Grant Tracking...

  17. 75 FR 51465 - Medicare Program; Announcement of Five New Members to the Advisory Panel on Ambulatory Payment...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-08-20

    ... Panel. This expertise encompasses hospital payment systems; hospital medical-care delivery systems; provider billing systems; APC groups, Current Procedural Terminology codes, and alpha-numeric Healthcare Common Procedure Coding System codes; and the use of, and payment for, drugs and medical devices in the...

  18. 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...

  19. 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.

  20. 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...

  1. 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...

  2. 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...

  3. The Theory of Value-Based Payment Incentives and Their Application to Health Care.

    PubMed

    Conrad, Douglas A

    2015-12-01

    To present the implications of agency theory in microeconomics, augmented by behavioral economics, for different methods of value-based payment in health care; and to derive a set of future research questions and policy recommendations based on that conceptual analysis. Original literature of agency theory, and secondarily behavioral economics, combined with applied research and empirical evidence on the application of those principles to value-based payment. Conceptual analysis and targeted review of theoretical research and empirical literature relevant to value-based payment in health care. Agency theory and secondarily behavioral economics have powerful implications for design of value-based payment in health care. To achieve improved value-better patient experience, clinical quality, health outcomes, and lower costs of care-high-powered incentives should directly target improved care processes, enhanced patient experience, and create achievable benchmarks for improved outcomes. Differing forms of value-based payment (e.g., shared savings and risk, reference pricing, capitation, and bundled payment), coupled with adjunct incentives for quality and efficiency, can be tailored to different market conditions and organizational settings. Payment contracts that are "incentive compatible"-which directly encourage better care and reduced cost, mitigate gaming, and selectively induce clinically efficient providers to participate-will focus differentially on evidence-based care processes, will right-size and structure incentives to avoid crowd-out of providers' intrinsic motivation, and will align patient incentives with value. Future research should address the details of putting these and related principles into practice; further, by deploying these insights in payment design, policy makers will improve health care value for patients and purchasers. © Health Research and Educational Trust.

  4. The impact of voting on tax payments

    PubMed Central

    Wahl, Ingrid; Muehlbacher, Stephan; Kirchler, Erich

    2010-01-01

    This study examines whether participating in governmental decisions influences taxpayers’ cooperation. The results of experiment 1 show that participants tend to contribute more when they can vote on different rules for a public good game. Experiment 2 reveals that tax payments are lowest in a tax simulation when participants benefit from tax payments and can not vote. However, when the participants did not benefit from tax payments, voting had no impact and cooperation was about the same as when participants benefited and could vote. Furthermore, voting increases procedural fairness and trust mediates the effect of procedural fairness on tax payments. PMID:21654938

  5. 34 CFR 1100.24 - What are the procedures for payment of a fellowship award directly to the fellow?

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... Does the Director Award a Fellowship? § 1100.24 What are the procedures for payment of a fellowship... Director determines the amount of a fellowship award, the fellowship recipient shall submit a payment... award directly to the fellow? 1100.24 Section 1100.24 Education Regulations Relating to Education...

  6. 34 CFR 1100.24 - What are the procedures for payment of a fellowship award directly to the fellow?

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... Does the Director Award a Fellowship? § 1100.24 What are the procedures for payment of a fellowship... Director determines the amount of a fellowship award, the fellowship recipient shall submit a payment... award directly to the fellow? 1100.24 Section 1100.24 Education Regulations Relating to Education...

  7. 34 CFR 1100.24 - What are the procedures for payment of a fellowship award directly to the fellow?

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... Does the Director Award a Fellowship? § 1100.24 What are the procedures for payment of a fellowship... Director determines the amount of a fellowship award, the fellowship recipient shall submit a payment... award directly to the fellow? 1100.24 Section 1100.24 Education Regulations Relating to Education...

  8. What Factors are Associated With 90-day Episode-of-care Payments for Younger Patients With Total Joint Arthroplasty?

    PubMed

    Pathak, Shweta; Ganduglia, Cecilia M; Awad, Samir S; Chan, Wenyaw; Swint, John M; Morgan, Robert O

    2017-11-01

    Total joint arthroplasty (TJA) has been identified as a procedure with substantial variations in inpatient and postacute care payments. Most studies in this area have focused primarily on the Medicare population and rarely have characterized the younger commercially insured populations. Understanding the inpatient and postdischarge care service-component differences across 90-day episodes of care and factors associated with payments for younger patients is crucial for successful implementation of bundled payments in TJA in non-Medicare populations. (1) To assess the mean total payment for a 90-day primary TJA episode, including the proportion attributable to postdischarge care, and (2) to evaluate the role of procedure, patient, and hospital-level factors associated with 90-day episode-of-care payments in a non-Medicare patient population younger than 65 years. Claims data for 2008 to 2013 from Blue Cross Blue Shield of Texas were obtained for primary TJAs. A total of 11,131 procedures were examined by aggregating payments for the index hospital stay and any postacute care including rehabilitation services and unplanned readmissions during the 90-day postdischarge followup period. A three-level hierarchical model was developed to determine procedure-, patient-, and hospital-level factors associated with 90-day episode-of-care payments. The mean total payment for a 90-day episode for TJA was USD 47,700 adjusted to 2013 USD. Only 14% of 90-day episode payments in our population was attributable to postdischarge-care services, which is substantially lower than the percentage estimated in the Medicare population. A prolonged length of stay (rate ratio [RR], 1.19; 95% CI, 1.15-1.23; p ≤ 0.001), any 90-day unplanned readmission (RR, 1.64; 95% CI, 1.57-1.71; p ≤ 0.001), computer-assisted surgery (RR, 1.031; 95% CI, 1.004-1.059; p ≤ 0.05), initial home discharge with home health component (RR, 1.029; 95% CI, 1.013-1.046; p ≤ 0.001), and very high patient morbidity burden (RR, 1.105; 95% CI, 1.062-1.150; p ≤ 0.001) were associated with increased TJA payments. Hospital-level factors associated with higher payments included urban location (RR, 1.29; 95% CI, 1.17-1.42; p ≤ 0.001), lower hospital case mix based on average relative diagnosis related group weight (RR, 0.94; 95% CI, 0.89-0.95; p ≤ 0.001), and large hospital size as defined by total discharge volume (RR, 1.082; 95% CI, 1.009-1.161; p ≤ 0.05). All procedure, patient, and hospital characterizing factors together explained 11% of variation among hospitals and 49% of variation among patients. Inpatient care contributed to a much larger proportion of total payments for 90-day care episodes for primary TJA in our younger than 65-year-old commercially insured population. Thus, inpatient care will continue to be an essential target for cost-containment and delivery strategies. A high percentage of hospital-level variation in episode payments remained unexplained by hospital characteristics in our study, suggesting system inefficiencies that could be suitable for bundling. However, replication of this study among other commercial payers in other parts of the country will allow for conclusions that are more robust and generalizable. Level II, economic analysis.

  9. Medicaid provider reimbursement policy for adult immunizations☆

    PubMed Central

    Stewart, Alexandra M.; Lindley, Megan C.; Cox, Marisa A.

    2015-01-01

    Background State Medicaid programs establish provider reimbursement policy for adult immunizations based on: costs, private insurance payments, and percentage of Medicare payments for equivalent services. Each program determines provider eligibility, payment amount, and permissible settings for administration. Total reimbursement consists of different combinations of Current Procedural Terminology codes: vaccine, vaccine administration, and visit. Objective Determine how Medicaid programs in the 50 states and the District of Columbia approach provider reimbursement for adult immunizations. Design Observational analysis using document review and a survey. Setting and participants Medicaid administrators in 50 states and the District of Columbia. Measurements Whether fee-for-service programs reimburse providers for: vaccines; their administration; and/or office visits when provided to adult enrollees. We assessed whether adult vaccination services are reimbursed when administered by a wide range of providers in a wide range of settings. Results Medicaid programs use one of 4 payment methods for adults: (1) a vaccine and an administration code; (2) a vaccine and visit code; (3) a vaccine code; and (4) a vaccine, visit, and administration code. Limitations Study results do not reflect any changes related to implementation of national health reform. Nine of fifty one programs did not respond to the survey or declined to participate, limiting the information available to researchers. Conclusions Medicaid reimbursement policy for adult vaccines impacts provider participation and enrollee access and uptake. While programs have generally increased reimbursement levels since 2003, each program could assess whether current policies reflect the most effective approach to encourage providers to increase vaccination services. PMID:26403369

  10. Medicaid provider reimbursement policy for adult immunizations.

    PubMed

    Stewart, Alexandra M; Lindley, Megan C; Cox, Marisa A

    2015-10-26

    State Medicaid programs establish provider reimbursement policy for adult immunizations based on: costs, private insurance payments, and percentage of Medicare payments for equivalent services. Each program determines provider eligibility, payment amount, and permissible settings for administration. Total reimbursement consists of different combinations of Current Procedural Terminology codes: vaccine, vaccine administration, and visit. Determine how Medicaid programs in the 50 states and the District of Columbia approach provider reimbursement for adult immunizations. Observational analysis using document review and a survey. Medicaid administrators in 50 states and the District of Columbia. Whether fee-for-service programs reimburse providers for: vaccines; their administration; and/or office visits when provided to adult enrollees. We assessed whether adult vaccination services are reimbursed when administered by a wide range of providers in a wide range of settings. Medicaid programs use one of 4 payment methods for adults: (1) a vaccine and an administration code; (2) a vaccine and visit code; (3) a vaccine code; and (4) a vaccine, visit, and administration code. Study results do not reflect any changes related to implementation of national health reform. Nine of fifty one programs did not respond to the survey or declined to participate, limiting the information available to researchers. Medicaid reimbursement policy for adult vaccines impacts provider participation and enrollee access and uptake. While programs have generally increased reimbursement levels since 2003, each program could assess whether current policies reflect the most effective approach to encourage providers to increase vaccination services. Copyright © 2015 Elsevier Ltd. All rights reserved.

  11. A risk-based prospective payment system that integrates patient, hospital and national costs.

    PubMed

    Siegel, C; Jones, K; Laska, E; Meisner, M; Lin, S

    1992-05-01

    We suggest that a desirable form for prospective payment for inpatient care is hospital average cost plus a linear combination of individual patient and national average cost. When the coefficients are chosen to minimize mean squared error loss between payment and costs, the payment has efficiency and access incentives. The coefficient multiplying patient costs is a hospital specific measure of financial risk of the patient. Access is promoted since providers receive higher reimbursements for risky, high cost patients. Historical cost data can be used to obtain estimates of payment parameters. The method is applied to Medicare data on psychiatric inpatients.

  12. Geographic variations in hospital charges and Medicare payments for major joint arthroplasty.

    PubMed

    Thakore, Rachel V; Greenberg, Sarah E; Bulka, Catherine M; Ehrenfeld, Jesse M; Obremskey, William T; Sethi, Manish K

    2015-05-01

    National data on hospital-level charges and Medicare payments have shown that joint arthroplasty is the most common surgical procedure among the elderly. Yet, no study has investigated micro and macro level geographic variations in hospital charges and payment. We used the Medicare Provider Charge Data to investigate Medicare payments and charges for 2750 hospitals accounting for 427,207 patients who underwent major joint arthroplasty and 932 hospitals for 18,714 patients who had a complication/comorbidity. We found a significant difference in hospital charges and payments based on geographic region (P<0.001). We concluded that hospital charges demonstrate a high variability even when using areas to control for differences in hospital wages and high variation in reimbursements in some areas remains unexplained by Medicare's current method of calculating reimbursement. Published by Elsevier Inc.

  13. Advanced Imaging Utilization Trends in Privately Insured Patients From 2007 to 2013.

    PubMed

    Horný, Michal; Burgess, James F; Cohen, Alan B

    2015-12-01

    The aim of the study was to investigate whether the increase in utilization of advanced diagnostic imaging for privately insured patients in 2011 was the beginning of a new trend in imaging utilization growth, or an isolated deviation from the declining trend that began in 2008. We extracted outpatient and inpatient CT, diagnostic ultrasound, MRI, and PET procedures from databases, for the years 2007 to 2013. This study extended previous work, covering 2012 to 2013, using the same methodology. For every year of the study period, we calculated the following: number of procedures per person-year covered by private health insurance; proportion of office and emergency visits that resulted in an imaging session; average payments per procedure; and total payments per person-year covered by private health insurance. Outpatient utilization of CT and PET decreased in both 2012 and 2013; outpatient utilization of MRI mildly increased in 2012, but then decreased in 2013. Outpatient utilization of diagnostic ultrasound showed a very different pattern, increasing throughout the study period. Inpatient utilization of all imaging modalities except PET decreased in both 2012 and 2013. Adjusted payments for all imaging modalities increased in 2012, and then dropped substantially in 2013, except the adjusted payments for diagnostic ultrasound that increased in 2013 again. The trend of increasing utilization of advanced diagnostic imaging seems to be over for some, but not all, imaging modalities. A combination of policy (eg, breast density notification laws), technologic advancement, and wider access seems to be responsible for at least part of an increasing utilization of diagnostic ultrasound. Copyright © 2015 American College of Radiology. All rights reserved.

  14. 45 CFR 302.75 - Procedures for the imposition of late payment fees on noncustodial parents who owe overdue support.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... on noncustodial parents who owe overdue support. 302.75 Section 302.75 Public Welfare Regulations....75 Procedures for the imposition of late payment fees on noncustodial parents who owe overdue support... noncustodial parents who owe overdue support. (b) If a State opts to impose late payment fees— (1) The late...

  15. 33 CFR 153.411 - Procedures for payment of judgments.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... SECURITY (CONTINUED) POLLUTION CONTROL OF POLLUTION BY OIL AND HAZARDOUS SUBSTANCES, DISCHARGE REMOVAL Administration of the Pollution Fund § 153.411 Procedures for payment of judgments. An owner or operator of a...

  16. 33 CFR 153.411 - Procedures for payment of judgments.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... SECURITY (CONTINUED) POLLUTION CONTROL OF POLLUTION BY OIL AND HAZARDOUS SUBSTANCES, DISCHARGE REMOVAL Administration of the Pollution Fund § 153.411 Procedures for payment of judgments. An owner or operator of a...

  17. 33 CFR 153.411 - Procedures for payment of judgments.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... SECURITY (CONTINUED) POLLUTION CONTROL OF POLLUTION BY OIL AND HAZARDOUS SUBSTANCES, DISCHARGE REMOVAL Administration of the Pollution Fund § 153.411 Procedures for payment of judgments. An owner or operator of a...

  18. 33 CFR 153.411 - Procedures for payment of judgments.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... SECURITY (CONTINUED) POLLUTION CONTROL OF POLLUTION BY OIL AND HAZARDOUS SUBSTANCES, DISCHARGE REMOVAL Administration of the Pollution Fund § 153.411 Procedures for payment of judgments. An owner or operator of a...

  19. 33 CFR 153.411 - Procedures for payment of judgments.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... SECURITY (CONTINUED) POLLUTION CONTROL OF POLLUTION BY OIL AND HAZARDOUS SUBSTANCES, DISCHARGE REMOVAL Administration of the Pollution Fund § 153.411 Procedures for payment of judgments. An owner or operator of a...

  20. Variation in Spending around Surgical Episodes of Urinary Stone Disease—Findings from Michigan

    PubMed Central

    Juan, Juan San; Hou, Hechuan; Ghani, Khurshid R.; Dupree, James M.; Hollingsworth, John M.

    2017-01-01

    Purpose To help rein in surgical spending, there is growing interest in the application of payment bundles to common outpatient procedures like ureteroscopy (URS) and shockwave lithotripsy (SWL). However, before urologists can move to such a payment system, they need to know where their episode costs are concentrated. Materials and Methods Using claims data from the Michigan Value Collaborative, we identified patients who underwent URS or SWL at hospitals in Michigan (2012 to 2015). We then totaled expenditures for all relevant services during these patients’ 30-day surgical episodes and categorized component payments [i.e., those for the index procedure, subsequent hospitalizations, professional services, and post-acute care (PAC)]. Finally, we quantified variation in total episode expenditures for URS and SWL across hospitals, examining drivers of this variation. Results In total, 9,449 URS and 6,446 SWL procedures were performed at 62 hospitals. Among these hospitals, there was three-fold variation in URS and SWL spending. The index procedure accounted for the largest payment difference between high- and low-cost hospitals (URS: $7,936 vs. $4,995, P<0.01; SWL: $4,832 vs. $3,207, P<0.01), followed by payments for PAC (URS: $2,207 vs. $1,711, P<0.01; SWL: $2,138 vs. $1,104, P<0.01). The index procedure explained 68% and 44%, and PAC payments explained 15% and 28% of the variation in episode spending for URS and SWL, respectively, across hospitals. Conclusions There exists substantial variation in ambulatory surgical spending across Michigan hospitals for urinary stone episodes, most of which can be explained by payment differences for the index procedure and PAC services. PMID:29180300

  1. 5 CFR 1215.8 - Procedures for salary offset.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 5 Administrative Personnel 3 2010-01-01 2010-01-01 false Procedures for salary offset. 1215.8... MANAGEMENT Salary Offset § 1215.8 Procedures for salary offset. (a) Deductions to liquidate an employee's... payment due to a separated employee including but not limited to final salary payment or leave in...

  2. The impacts of DRG-based payments on health care provider behaviors under a universal coverage system: a population-based study.

    PubMed

    Cheng, Shou-Hsia; Chen, Chi-Chen; Tsai, Shu-Ling

    2012-10-01

    To examine the impacts of diagnosis-related group (DRG) payments on health care provider's behavior under a universal coverage system in Taiwan. This study employed a population-based natural experiment study design. Patients who underwent coronary artery bypass graft surgery or percutaneous transluminal coronary angioplasty, which were incorporated in the Taiwan version of DRG payments in 2010, were defined as the intervention group. The comparison group consisted of patients who underwent cardiovascular procedures which were paid for by fee-for-services schemes and were selected by propensity score matching from patients treated by the same group of surgeons. The generalized estimating equations model and difference-in-difference analysis was used in this study. The introduction of DRG payment resulted in a 10% decrease (p<0.001) in patient's length of stay in the intervention group in relation to the comparison group. The intensity of care slightly declined with p<0.001. No significant changes were found concerning health care outcomes measured by emergency department visits, readmissions, and mortality after discharge. The DRG-based payment resulted in reduced intensity of care and shortened length of stay. The findings might be valuable to other countries that are developing or reforming their payment system under a universal coverage system. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  3. 32 CFR 299.5 - Procedures.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... has a history of prompt payment. A history of prompt payment means payment within 30 calendar days of... payment before processing is continued if the requester does not have a history of prompt payment. All.... (3) When a requester has previously failed to pay a fee charged within a timely fashion (i.e., within...

  4. 50 CFR 11.17 - Payment of final assessment.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... PLANTS CIVIL PROCEDURES Assessment Procedure § 11.17 Payment of final assessment. When a final... request the Attorney General to institute a civil action in the U.S. District Court to collect the penalty. ...

  5. Cross-sectional Analysis of the Relationship between Paranasal Sinus Balloon Catheter Dilations and Industry Payments among Otolaryngologists.

    PubMed

    Fujiwara, Rance J T; Shih, Allen F; Mehra, Saral

    2017-11-01

    Objective To characterize the relationship between industry payments and use of paranasal sinus balloon catheter dilations (BCDs) for chronic rhinosinusitis. Study Design Cross-sectional analysis of Medicare B Public Use Files and Open Payments data. Setting Two national databases, 2013 to 2014. Subjects and Methods Physicians with Medicare claims with Current Procedural Terminology codes 31295 to 31297 were identified and cross-referenced with industry payments. Multivariate linear regression controlling for age, race, sex, and comorbidity in a physician's Medicare population was performed to identify associations between use of BCDs and industry payments. The final analysis included 334 physicians performing 31,506 procedures, each of whom performed at least 11 balloon dilation procedures. Results Of 334 physicians, 280 (83.8%) received 4392 industry payments in total. Wide variation in payments to physicians was noted (range, $43.29-$111,685.10). The median payment for food and beverage was $19.26 and that for speaker or consulting fees was $409.45. One payment was associated with an additional 3.05 BCDs (confidence interval [95% CI],1.65-4.45; P < .001). One payment for food and beverages was associated with 3.81 additional BCDs (95% CI, 2.13-5.49; P < .001), and 1 payment for speaker or consulting fees was associated with 5.49 additional BCDs (95% CI, 0.32-10.63; P = .04). Conclusion Payments by manufacturers of BCD devices were associated with increased use of BCD for chronic rhinosinusitis. On separate analyses, the number of payments for food and beverages as well as that for speaker and consulting fees was associated with increased BCD use. This study was cross-sectional and cannot prove causality, and several factors likely exist for the uptrend in BCD use.

  6. 12 CFR 622.60 - Payment of civil money penalty.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 12 Banks and Banking 7 2014-01-01 2014-01-01 false Payment of civil money penalty. 622.60 Section... Rules and Procedures for Assessment and Collection of Civil Money Penalties § 622.60 Payment of civil money penalty. (a) Payment date. Generally, the date designated in the notice of assessment for payment...

  7. 12 CFR 622.60 - Payment of civil money penalty.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 12 Banks and Banking 6 2011-01-01 2011-01-01 false Payment of civil money penalty. 622.60 Section... Rules and Procedures for Assessment and Collection of Civil Money Penalties § 622.60 Payment of civil money penalty. (a) Payment date. Generally, the date designated in the notice of assessment for payment...

  8. 12 CFR 622.60 - Payment of civil money penalty.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 12 Banks and Banking 7 2012-01-01 2012-01-01 false Payment of civil money penalty. 622.60 Section... Rules and Procedures for Assessment and Collection of Civil Money Penalties § 622.60 Payment of civil money penalty. (a) Payment date. Generally, the date designated in the notice of assessment for payment...

  9. 12 CFR 622.60 - Payment of civil money penalty.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 12 Banks and Banking 7 2013-01-01 2013-01-01 false Payment of civil money penalty. 622.60 Section... Rules and Procedures for Assessment and Collection of Civil Money Penalties § 622.60 Payment of civil money penalty. (a) Payment date. Generally, the date designated in the notice of assessment for payment...

  10. 12 CFR 622.60 - Payment of civil money penalty.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 12 Banks and Banking 6 2010-01-01 2010-01-01 false Payment of civil money penalty. 622.60 Section... Rules and Procedures for Assessment and Collection of Civil Money Penalties § 622.60 Payment of civil money penalty. (a) Payment date. Generally, the date designated in the notice of assessment for payment...

  11. 20 CFR 404.1807 - Monthly payment day.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... in writing if your monthly payment day is being changed to the 3rd of the month due to this provision... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false Monthly payment day. 404.1807 Section 404... INSURANCE (1950- ) Payment Procedures § 404.1807 Monthly payment day. (a) General. Once we have made a...

  12. Payment reform to finance a medical home: comment on "Achieving cost control, care coordination, and quality improvement through incremental payment system reform".

    PubMed

    McGuire, Thomas G

    2010-01-01

    This commentary on R. F. Averill et al. (2010) addresses their idea of risk and quality adjusting fee-for-service payments to primary care physicians in order to improve the efficiency of primary care and take a step toward financing a "medical home"for patients. I show how their idea can create incentives for efficient practice styles. Pairing this with an active beneficiary choice of primary care physician with an enrollment fee would make the idea easier to implement and provide an incentive and the financing for elements of service not covered by procedure-based fees.

  13. Combining DRGs and per diem payments in the private sector: the Equitable Payment Model.

    PubMed

    Hanning, Brian W T

    2005-02-01

    The many types of payment models used in the Australian private sector are reviewed. Their features are compared and contrasted to those desirable in an optimal private sector payment model. The EPM(TM) (Equitable Payment Model) is discussed and its consistency with the desirable features of an optimal private sector payment model outlined. These include being based on a robust classification system, nationally benchmarked length of stay (LOS) results, nationally benchmarked relative cost and encouraging continual improvement in efficiency to the benefit of both health funds and private hospitals. The advantages in the context of the private sector of EPM(TM) being a per diem model, albeit very different to current per diem models, are discussed. The advantages of EPM(TM) for hospitals and health funds are outlined.

  14. Combining auctions and performance-based payments in a forest enrichment field trial in Western Kenya.

    PubMed

    Khalumba, Mercelyne; Wünscher, Tobias; Wunder, Sven; Büdenbender, Mirjam; Holm-Müller, Karin

    2014-06-01

    Cost-effectiveness is an important aspect in the assessment of payments for environmental services (PES) initiatives. In participatory field trials with communities in Western Kenya, we combined procurement auctions for forest enrichment contracts with performance-based payments and compared the outcomes with a baseline scenario currently used by the Kenyan Forest Service. Procurement auctions were the most cost-effective. The competitive nature of the auction reduced contracting expenses (provision costs), and the result-oriented payments provided additional incentives to care for the planted seedlings, resulting in their improved survival rates (service quantity). These gains clearly exceeded increases in transaction costs associated with conducting an auction. The number of income-poor auction participants and winners was disproportionately high and local institutional buy-in was remarkably strong. Our participatory approach may, however, require adaptations when conducted at a larger scale. Although the number of contracts we monitored was limited and prohibited the use of statistical tests, our study is one of the first to reveal the benefits of using auctions for PES in developing countries. © 2014 Society for Conservation Biology.

  15. 28 CFR 79.75 - Procedures for payment of claims.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... reimbursement for burial expenses; (v) Loans or loan guarantees; (vi) Education benefits and payments; (vii) Vocational rehabilitation benefits and payments; (viii) Medical, hospital, and dental benefits; or (ix...

  16. 42 CFR 414.46 - Additional rules for payment of anesthesia services.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    .... (a) Definitions. For purposes of this section, the following definitions apply: (1) Base unit means the value for each anesthesia code that reflects all activities other than anesthesia time. These... furnishes the carrier with the base units for each anesthesia procedure code. The base units are derived...

  17. 42 CFR 414.46 - Additional rules for payment of anesthesia services.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    .... (a) Definitions. For purposes of this section, the following definitions apply: (1) Base unit means the value for each anesthesia code that reflects all activities other than anesthesia time. These... furnishes the carrier with the base units for each anesthesia procedure code. The base units are derived...

  18. [Management of hospitals in the prospective payment system].

    PubMed

    Konishi, Toshiro

    2004-08-01

    Since last year a prospective payment system, the so-called "diagnosis procedure combination" system has been implemented at 82 hospitals, and this fiscal year national universities and national hospitals became independent agencies. Furthermore, a new postgraduate training and education system started this year. Now it is time for hospitals to transform into institutions that are opted for by health professionals, patients, and medical students. Every hospital has to transform into a hospital that provides safe health care with a minimal number of medical errors and delivers care with a degree of information, transparency and logicality that will fully satisfy patients. That care must also be distinguished by efficiency giving proper consideration to costs. For this purpose, all hospital staff including physicians, nurses, technicians, pharmacists, dietitians, and clerical staff have to pursue health care as a team. In a comprehensive health care system, practice of team-based care is imperative. As we think that the implementation of critical paths (or clinical paths) will be a strong impetus for team-centered care and, especially important, for a change in the mindset of the physicians, we have addressed this subject.

  19. 29 CFR 100.610 - Written demand for payment.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 29 Labor 2 2010-07-01 2010-07-01 false Written demand for payment. 100.610 Section 100.610 Labor... Procedures § 100.610 Written demand for payment. (a) The NLRB will promptly make written demand upon the debtor for payment of money or the return of specific property. The written demand for payment will be...

  20. 47 CFR 1.1182 - Schedule of fees for products and services provided by the Commission in connection with...

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 47 Telecommunication 1 2010-10-01 2010-10-01 false Schedule of fees for products and services... Procedures for Payment § 1.1182 Schedule of fees for products and services provided by the Commission in connection with competitive bidding procedures. Product or service Fee amount Payment procedure On-line...

  1. 12 CFR 219.6 - Payment procedures.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... PROVIDING FINANCIAL RECORDS; RECORDKEEPING REQUIREMENTS FOR CERTAIN FINANCIAL RECORDS (REGULATION S) Reimbursement to Financial Institutions for Providing Financial Records § 219.6 Payment procedures. (a) Notice to submit invoice. Promptly following a service of legal process or request, the court or government...

  2. 12 CFR 219.6 - Payment procedures.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... PROVIDING FINANCIAL RECORDS; RECORDKEEPING REQUIREMENTS FOR CERTAIN FINANCIAL RECORDS (REGULATION S) Reimbursement to Financial Institutions for Providing Financial Records § 219.6 Payment procedures. (a) Notice to submit invoice. Promptly following a service of legal process or request, the court or government...

  3. 12 CFR 219.6 - Payment procedures.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... PROVIDING FINANCIAL RECORDS; RECORDKEEPING REQUIREMENTS FOR CERTAIN FINANCIAL RECORDS (REGULATION S) Reimbursement to Financial Institutions for Providing Financial Records § 219.6 Payment procedures. (a) Notice to submit invoice. Promptly following a service of legal process or request, the court or government...

  4. 12 CFR 219.6 - Payment procedures.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... PROVIDING FINANCIAL RECORDS; RECORDKEEPING REQUIREMENTS FOR CERTAIN FINANCIAL RECORDS (REGULATION S) Reimbursement to Financial Institutions for Providing Financial Records § 219.6 Payment procedures. (a) Notice to submit invoice. Promptly following a service of legal process or request, the court or government...

  5. 23 CFR 140.920 - Lump sum payments.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 23 Highways 1 2010-04-01 2010-04-01 false Lump sum payments. 140.920 Section 140.920 Highways FEDERAL HIGHWAY ADMINISTRATION, DEPARTMENT OF TRANSPORTATION PAYMENT PROCEDURES REIMBURSEMENT Reimbursement for Railroad Work § 140.920 Lump sum payments. Where approved by FHWA, pursuant to 23 CFR 646.216...

  6. 23 CFR 140.920 - Lump sum payments.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 23 Highways 1 2011-04-01 2011-04-01 false Lump sum payments. 140.920 Section 140.920 Highways FEDERAL HIGHWAY ADMINISTRATION, DEPARTMENT OF TRANSPORTATION PAYMENT PROCEDURES REIMBURSEMENT Reimbursement for Railroad Work § 140.920 Lump sum payments. Where approved by FHWA, pursuant to 23 CFR 646.216...

  7. 23 CFR 140.920 - Lump sum payments.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 23 Highways 1 2013-04-01 2013-04-01 false Lump sum payments. 140.920 Section 140.920 Highways FEDERAL HIGHWAY ADMINISTRATION, DEPARTMENT OF TRANSPORTATION PAYMENT PROCEDURES REIMBURSEMENT Reimbursement for Railroad Work § 140.920 Lump sum payments. Where approved by FHWA, pursuant to 23 CFR 646.216...

  8. 23 CFR 140.920 - Lump sum payments.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 23 Highways 1 2014-04-01 2014-04-01 false Lump sum payments. 140.920 Section 140.920 Highways FEDERAL HIGHWAY ADMINISTRATION, DEPARTMENT OF TRANSPORTATION PAYMENT PROCEDURES REIMBURSEMENT Reimbursement for Railroad Work § 140.920 Lump sum payments. Where approved by FHWA, pursuant to 23 CFR 646.216...

  9. 22 CFR 201.66 - Side payments.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 22 Foreign Relations 1 2010-04-01 2010-04-01 false Side payments. 201.66 Section 201.66 Foreign Relations AGENCY FOR INTERNATIONAL DEVELOPMENT RULES AND PROCEDURES APPLICABLE TO COMMODITY TRANSACTIONS FINANCED BY USAID Price Provisions § 201.66 Side payments. Any payment which an importer makes to a...

  10. 22 CFR 201.66 - Side payments.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 22 Foreign Relations 1 2013-04-01 2013-04-01 false Side payments. 201.66 Section 201.66 Foreign Relations AGENCY FOR INTERNATIONAL DEVELOPMENT RULES AND PROCEDURES APPLICABLE TO COMMODITY TRANSACTIONS FINANCED BY USAID Price Provisions § 201.66 Side payments. Any payment which an importer makes to a...

  11. 22 CFR 201.66 - Side payments.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 22 Foreign Relations 1 2014-04-01 2014-04-01 false Side payments. 201.66 Section 201.66 Foreign Relations AGENCY FOR INTERNATIONAL DEVELOPMENT RULES AND PROCEDURES APPLICABLE TO COMMODITY TRANSACTIONS FINANCED BY USAID Price Provisions § 201.66 Side payments. Any payment which an importer makes to a...

  12. 22 CFR 201.66 - Side payments.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 22 Foreign Relations 1 2011-04-01 2011-04-01 false Side payments. 201.66 Section 201.66 Foreign Relations AGENCY FOR INTERNATIONAL DEVELOPMENT RULES AND PROCEDURES APPLICABLE TO COMMODITY TRANSACTIONS FINANCED BY USAID Price Provisions § 201.66 Side payments. Any payment which an importer makes to a...

  13. 22 CFR 201.66 - Side payments.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 22 Foreign Relations 1 2012-04-01 2012-04-01 false Side payments. 201.66 Section 201.66 Foreign Relations AGENCY FOR INTERNATIONAL DEVELOPMENT RULES AND PROCEDURES APPLICABLE TO COMMODITY TRANSACTIONS FINANCED BY USAID Price Provisions § 201.66 Side payments. Any payment which an importer makes to a...

  14. 45 CFR 1801.53 - Postponement of payment.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 45 Public Welfare 4 2012-10-01 2012-10-01 false Postponement of payment. 1801.53 Section 1801.53 Public Welfare Regulations Relating to Public Welfare (Continued) HARRY S. TRUMAN SCHOLARSHIP FOUNDATION HARRY S. TRUMAN SCHOLARSHIP PROGRAM Payment Conditions and Procedures § 1801.53 Postponement of payment...

  15. 45 CFR 1801.53 - Postponement of payment.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 45 Public Welfare 4 2013-10-01 2013-10-01 false Postponement of payment. 1801.53 Section 1801.53 Public Welfare Regulations Relating to Public Welfare (Continued) HARRY S. TRUMAN SCHOLARSHIP FOUNDATION HARRY S. TRUMAN SCHOLARSHIP PROGRAM Payment Conditions and Procedures § 1801.53 Postponement of payment...

  16. 45 CFR 1801.53 - Postponement of payment.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 45 Public Welfare 4 2011-10-01 2011-10-01 false Postponement of payment. 1801.53 Section 1801.53 Public Welfare Regulations Relating to Public Welfare (Continued) HARRY S. TRUMAN SCHOLARSHIP FOUNDATION HARRY S. TRUMAN SCHOLARSHIP PROGRAM Payment Conditions and Procedures § 1801.53 Postponement of payment...

  17. 45 CFR 1801.53 - Postponement of payment.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 45 Public Welfare 4 2014-10-01 2014-10-01 false Postponement of payment. 1801.53 Section 1801.53 Public Welfare Regulations Relating to Public Welfare (Continued) HARRY S. TRUMAN SCHOLARSHIP FOUNDATION HARRY S. TRUMAN SCHOLARSHIP PROGRAM Payment Conditions and Procedures § 1801.53 Postponement of payment...

  18. 45 CFR 1801.53 - Postponement of payment.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 45 Public Welfare 4 2010-10-01 2010-10-01 false Postponement of payment. 1801.53 Section 1801.53 Public Welfare Regulations Relating to Public Welfare (Continued) HARRY S. TRUMAN SCHOLARSHIP FOUNDATION HARRY S. TRUMAN SCHOLARSHIP PROGRAM Payment Conditions and Procedures § 1801.53 Postponement of payment...

  19. The impact of DRGs on the cost and quality of health care in the United States.

    PubMed

    Davis, C; Rhodes, D J

    1988-01-01

    The prospective Payment System (PPS) represents a fundamental change in the way the United States government reimburses hospitals for medical services covered under Medicare, a federal health care insurance program for the elderly and disabled. PPS replaced the retrospective cost-based system of payment for Medicare services with a prospective payment system. Under PPS, a predetermined specific rate for each discharge dictates payment according to the diagnosis related group (DRG) in which the discharge is classified. The PPS was intended to create financial incentives that encourage hospitals to restrain the use of resources while providing high-quality inpatient care. Both objectives appear to have been met under PPS. Hospital utilization has declined, average length of stay has fallen, and the locus of care has shifted from the inpatient setting to less costly outpatient settings. The growth in inpatient hospital benefits has slowed and the impending insolvency of the Medicare trust fund has been forestalled. Studies have found no deterioration in the quality of care rendered to Medicare beneficiaries. Neither the mortality rate nor the rate of re-admission (presumably related to premature discharge) increased under PPS. Indeed, PPS appears to have enhanced the quality of inpatient care by discouraging unnecessary and potentially harmful procedures, and by encouraging the concentration of complex procedures in facilities in which the high frequency of these procedures promotes efficiency. Incentive-based reimbursement also appears to have contributed to the growth in alternative delivery systems, such as HMOs and PPOs, which contain costs by maintaining a high volume of a limited range of services. The success of the PPS/DRG system in controlling costs and promoting quality in this country suggests its application in other countries, either as a method of reimbursement or as a product line management tool.

  20. Why do we pay? A national survey of investigators and IRB chairpersons

    PubMed Central

    Ripley, Elizabeth; Macrina, Francis; Markowitz, Monika; Gennings, Chris

    2011-01-01

    The principle that payment to participants should not be undue or coercive is the consensus of international and national guidelines and ethical debates; however, what this means in practice is unclear. This study determined the attitudes and practices of IRB chairpersons and investigators regarding participant payment. One thousand six hundred investigators and 1900 IRB chairpersons received an invitation to participate in a web-based survey. Four hundred and fifty-five investigators (28.3%) and 395 IRB chairpersons (18.6%) responded. The survey was designed to gather considerations that govern payment determination and practical application of these considerations in hypothetical case studies. The survey asked best answer, multiple choice, and open text questions. Short hypothetical case scenarios where presented, and participants were asked to rate factors in the study that might impact payment and then determine their recommended payment. A predictive model was developed for each case to determine factors which affected payment. Although compensation was the primary reason given to justify payment by both investigators and IRB chairpersons, the cases suggested that, in practice, payment is often guided by incentive, as shown by the impact of anticipated difficulty recruiting, inconvenience, and risk in determining payment. Payment models varied by type of study. Ranges for recommended payments by both groups for different types of procedures and studies are presented. PMID:20831420

  1. 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.

  2. 5 CFR 1620.35 - Loan payments.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 5 Administrative Personnel 3 2010-01-01 2010-01-01 false Loan payments. 1620.35 Section 1620.35... Nonappropriated Fund Employees § 1620.35 Loan payments. NAF instrumentalities must deduct and transmit TSP loan... CFR part 1655 and Board procedures. Loan payments may not be deducted and transmitted for employees...

  3. Why bundled payments could drive innovation: an example from interventional oncology.

    PubMed

    Steele, Joseph R; Jones, A Kyle; Ninan, Elizabeth P; Clarke, Ryan K; Odisio, Bruno C; Avritscher, Rony; Murthy, Ravi; Mahvash, Armeen

    2015-03-01

    Some have suggested that the current fee-for-service health care payment system in the United States stifles innovation. However, there are few published examples supporting this concept. We implemented an innovative temporary balloon occlusion technique for yttrium 90 radioembolization of nonresectable liver cancer. Although our balloon occlusion technique was associated with similar patient outcomes, lower cost, and faster procedure times compared with the standard-of-care coil embolization technique, our technique failed to gain widespread acceptance. Financial analysis revealed that because the balloon occlusion technique avoided a procedural step associated with a lucrative Current Procedural Terminology billing code, this new technique resulted in a significant decrease in hospital and physician revenue in the current fee-for-service payment system, even though the new technique would provide a revenue enhancement through cost savings in a bundled payment system. Our analysis illustrates how in a fee-for-service payment system, financial disincentives can stifle innovation and advancement of health care delivery. Copyright © 2015 by American Society of Clinical Oncology.

  4. Function-based payment model for inpatient medical rehabilitation: an evaluation.

    PubMed

    Sutton, J P; DeJong, G; Wilkerson, D

    1996-07-01

    To describe the components of a function-based prospective payment model for inpatient medical rehabilitation that parallels diagnosis-related groups (DRGs), to evaluate this model in relation to stakeholder objectives, and to detail the components of a quality of care incentive program that, when combined with this payment model, creates an incentive for provides to maximize functional outcomes. This article describes a conceptual model, involving no data collection or data synthesis. The basic payment model described parallels DRGs. Information on the potential impact of this model on medical rehabilitation is gleaned from the literature evaluating the impact of DRGs. The conceptual model described is evaluated against the results of a Delphi Survey of rehabilitation providers, consumers, policymakers, and researchers previously conducted by members of the research team. The major shortcoming of a function-based prospective payment model for inpatient medical rehabilitation is that it contains no inherent incentive to maximize functional outcomes. Linkage of reimbursement to outcomes, however, by withholding a fixed proportion of the standard FRG payment amount, placing that amount in a "quality of care" pool, and distributing that pool annually among providers whose predesignated, facility-level, case-mix-adjusted outcomes are attained, may be one strategy for maximizing outcome goals.

  5. Payment models to support population health management.

    PubMed

    Huerta, Timothy R; Hefner, Jennifer L; McAlearney, Ann Scheck

    2014-01-01

    To survey the policy-driven financial controls currently being used to drive physician change in the care of populations. This paper offers a review of current health care payment models and discusses the impact of each on the potential success of PHM initiatives. We present the benefits of a multi-part model, combining visit-based fee-for-service reimbursement with a monthly "care coordination payment" and a performance-based payment system. A multi-part model removes volume-based incentives and promotes efficiency. However, it is predicated on a pay-for-performance framework that requires standardized measurement. Application of this model is limited due to the current lack of standardized measurement of quality goals that are linked to payment incentives. Financial models dictated by health system payers are inextricably linked to the organization and management of health care. There is a need for better measurements and realistic targets as part of a comprehensive system of measurement assessment that focuses on practice redesign, with the goal of standardizing measurement of the structure and process of redesign. Payment reform is a necessary component of an accurate measure of the associations between practice transformation and outcomes important to both patients and society.

  6. Hospital volume, complications, and cost of cancer surgery in the elderly.

    PubMed

    Nathan, Hari; Atoria, Coral L; Bach, Peter B; Elkin, Elena B

    2015-01-01

    Hospital surgical volume has been shown to correlate with short-term outcomes after cancer surgery, but the relationship between volume and cost of care is unclear. We sought to characterize variation in payments for cancer surgery and assess the relationship between hospital volume and payments. Using 2000 to 2007 Surveillance, Epidemiology, and End Results-Medicare data, we assessed risk-adjusted 30-day episode Medicare payments for elderly patients undergoing one of six procedures for resection of cancer. Payments for the index hospitalization, readmissions, physician services, emergency room visits, and postdischarge ancillary care were analyzed, as were data on 30-day mortality and complications. The analysis included 31,191 colectomies, 2,670 cystectomies, 1,514 pancreatectomies, 2,607 proctectomies, 12,228 prostatectomies, and 10,151 pulmonary lobectomies. There was substantial variation in cost; differences between the first and third terciles of cost varied from 27% for cystectomy to 40% for colectomy. The majority of variation (66% to 82%) was attributable to payments for the index admission rather than readmissions or physician services. There were no meaningful associations between total risk-adjusted payments and hospital volume. Surgical mortality was low, but complication rates ranged from 10% (prostatectomy) to 56% (lobectomy). Complication rates were not correlated with hospital volume, but occurrence of complications was associated with 47% to 70% higher costs. We found substantial variation in Medicare payments for these six cancer procedures. Cost was strongly associated with postoperative complications and primarily driven by differences in the cost of the index hospitalization. Efforts to prevent and cost-effectively manage complications are more likely to reduce costs than volume-based referral of cancer surgery alone. © 2014 by American Society of Clinical Oncology.

  7. 48 CFR 232.1004 - Procedures.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... Section 232.1004 Federal Acquisition Regulations System DEFENSE ACQUISITION REGULATIONS SYSTEM, DEPARTMENT OF DEFENSE GENERAL CONTRACTING REQUIREMENTS CONTRACT FINANCING Performance-Based Payments 232.1004..., completion criteria and event values along with the projected expenditure profile in order to negotiate the...

  8. 48 CFR 570.502-2 - Procedures.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... Services. Reference the lease on the form. (h) Inspection and payment. Do not make final payment for... 48 Federal Acquisition Regulations System 4 2010-10-01 2010-10-01 false Procedures. 570.502-2 Section 570.502-2 Federal Acquisition Regulations System GENERAL SERVICES ADMINISTRATION SPECIAL...

  9. 29 CFR 1949.4 - Procedure for payment.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 29 Labor 9 2010-07-01 2010-07-01 false Procedure for payment. 1949.4 Section 1949.4 Labor Regulations Relating to Labor (Continued) OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION, DEPARTMENT OF LABOR (CONTINUED) OFFICE OF TRAINING AND EDUCATION, OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION OSHA Training...

  10. 29 CFR 1949.4 - Procedure for payment.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 29 Labor 9 2011-07-01 2011-07-01 false Procedure for payment. 1949.4 Section 1949.4 Labor Regulations Relating to Labor (Continued) OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION, DEPARTMENT OF LABOR (CONTINUED) OFFICE OF TRAINING AND EDUCATION, OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION OSHA Training...

  11. Economic factors affecting head and neck reconstructive microsurgery: the surgeons' and hospital's perspective.

    PubMed

    Deleyiannis, Frederic W-B; Porter, Andrew C

    2007-07-01

    The purpose of this study was to determine the relative financial value of providing the service of free-tissue transfer for head and neck reconstruction from the surgeons' and hospital's perspective. Medical and hospital accounting records of 58 consecutive patients undergoing head and neck resections and simultaneous free-flap reconstruction were reviewed. Software from the Center for Medicare and Medicaid Services was used to calculate anticipated Medicare payments to the surgeon based on current procedural terminology codes and to the hospital based on diagnosis-related group codes. The mean actual payment to the surgeon for a free flap was $2300.60. This payment was 91.6 percent ($2300 out of $2510) of the calculated payment if all payments had been reimbursed by Medicare. Total charges and total payment to the hospital for the 58 patients were $19,148,852 and $2,765,552, respectively. After covering direct costs, total hospital revenue (i.e., margin) was $1,056,886. The mostly commonly assigned diagnosis-related group code was 482 (n = 35). According to the fee schedule for that code, if Medicare had been the insurance plan for these 35 patients, the mean payment to the hospital would have been $45,840. The actual mean hospital payment was $44,133. This actual hospital payment represents 96 percent of the calculated Medicare hospital payment ($44,133 of $45,840). Free-flap reconstruction of the head and neck generates substantial revenue for the hospital. For their mutual benefit, hospitals should join with physicians in contract negotiations of physician reimbursement with insurance companies. Bolstered reimbursement figures would better attract and retain skilled surgeons dedicated to microvascular reconstruction.

  12. A new accounting system for financial balance based on personnel cost after the introduction of a DPC/DRG system.

    PubMed

    Nakagawa, Yoshiaki; Takemura, Tadamasa; Yoshihara, Hiroyuki; Nakagawa, Yoshinobu

    2011-04-01

    A hospital director must estimate the revenues and expenses not only in a hospital but also in each clinical division to determine the proper management strategy. A new prospective payment system based on the Diagnosis Procedure Combination (DPC/PPS) introduced in 2003 has made the attribution of revenues and expenses for each clinical department very complicated because of the intricate involvement between the overall or blanket component and a fee-for service (FFS). Few reports have so far presented a programmatic method for the calculation of medical costs and financial balance. A simple method has been devised, based on personnel cost, for calculating medical costs and financial balance. Using this method, one individual was able to complete the calculations for a hospital which contains 535 beds and 16 clinics, without using the central hospital computer system.

  13. 45 CFR 96.12 - Grant payment.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 45 Public Welfare 1 2010-10-01 2010-10-01 false Grant payment. 96.12 Section 96.12 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION BLOCK GRANTS General Procedures § 96.12 Grant payment. The Secretary will make payments at such times and in such amounts to each State from its awards...

  14. 42 CFR 488.450 - Continuation of payments to a facility with deficiencies.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 5 2010-10-01 2010-10-01 false Continuation of payments to a facility with... PROCEDURES Enforcement of Compliance for Long-Term Care Facilities with Deficiencies § 488.450 Continuation of payments to a facility with deficiencies. (a) Criteria. (1) CMS may continue payments to a...

  15. 24 CFR 203.22 - Payment of insurance premiums or charges; prepayment privilege.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 24 Housing and Urban Development 2 2010-04-01 2010-04-01 false Payment of insurance premiums or... Underwriting Procedures Eligible Mortgages § 203.22 Payment of insurance premiums or charges; prepayment privilege. (a) Payment of periodic insurance premiums or charges. Except with respect to mortgages for which...

  16. 24 CFR 203.22 - Payment of insurance premiums or charges; prepayment privilege.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 24 Housing and Urban Development 2 2011-04-01 2011-04-01 false Payment of insurance premiums or... Underwriting Procedures Eligible Mortgages § 203.22 Payment of insurance premiums or charges; prepayment privilege. (a) Payment of periodic insurance premiums or charges. Except with respect to mortgages for which...

  17. 42 CFR 431.972 - Claims sampling procedures.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... Estimating Improper Payments in Medicaid and CHIP § 431.972 Claims sampling procedures. (a) Claims universe. (1) The PERM claims universe includes payments that were originally paid (paid claims) and for which... must establish controls to ensure FFS and managed care universes are accurate and complete, including...

  18. 42 CFR 431.972 - Claims sampling procedures.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... Estimating Improper Payments in Medicaid and CHIP § 431.972 Claims sampling procedures. (a) Claims universe. (1) The PERM claims universe includes payments that were originally paid (paid claims) and for which... must establish controls to ensure FFS and managed care universes are accurate and complete, including...

  19. 42 CFR 431.972 - Claims sampling procedures.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... Estimating Improper Payments in Medicaid and CHIP § 431.972 Claims sampling procedures. (a) Claims universe. (1) The PERM claims universe includes payments that were originally paid (paid claims) and for which... must establish controls to ensure FFS and managed care universes are accurate and complete, including...

  20. 28 CFR 505.6 - Procedures for payment.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... ADMINISTRATION COST OF INCARCERATION FEE § 505.6 Procedures for payment. Fees imposed pursuant to this part are... financial responsibility program (see 28 CFR part 545, subpart B), fees are to be included under the... included in that same category. Fees may be subject to interest charges. ...

  1. Who's doing the math? Are we really compensating research participants?

    PubMed

    Ripley, Elizabeth; Macrina, Francis; Markowitz, Monika; Gennings, Chris

    2010-09-01

    Although compensation for expenses to participants in research projects is considered important and the primary reason for paying, there is no evidence to support that investigators and IRB members actually calculate participant cost. Payment recommendations for six hypothetical studies were obtained from a national survey of IRB chairpersons (N = 353) and investigators (N = 495). Survey respondents also recommended payment for specific study procedures. We calculated participant cost for the six hypothetical cases both by procedures and by time involvement. A large percentage recommended only token payments for survey, registry, and medical record review studies. Most chose payment for pharmaceutical studies but the recommended payment did not compensate for calculated costs. Results suggest that compensation and reimbursement as the primary reasons for paying research participants may not match actual practice.

  2. 20 CFR 416.1406 - Testing modifications to the disability determination procedures.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... specializes in a field of medicine appropriate to the child's impairment(s), evaluates the claim of such child... respect to the disability of a child under age 18 claiming SSI payments based on disability, the...

  3. 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.

  4. Do Case Rates Affect Physicians' Clinical Practice in Radiation Oncology?: An Observational Study

    PubMed Central

    Loy, Bryan A.; Shkedy, Clive I.; Powell, Adam C.; Happe, Laura E.; Royalty, Julie A.; Miao, Michael T.; Smith, Gary L.; Long, James W.; Gupta, Amit K.

    2016-01-01

    Case rate payments combined with utilization monitoring may have the potential to improve the quality of care by reducing over and under-treatment. Thus, a national managed care organization introduced case rate payments at one multi-site radiation oncology provider while maintaining only fee-for-service payments at others. This study examined whether the introduction of the payment method had an effect on radiation fractions administered when compared to clinical guidelines. The number of fractions of radiation therapy delivered to patients with bone metastases, breast, lung, prostate, and skin cancer was assessed for concordance with clinical guidelines. The proportion of guideline-based care ascertained from the payer's claims database was compared before (2011) and after (2013) the payment method introduction using relative risks (RR). After the introduction of case rates, there were no significant changes in guideline-based care in breast, lung, and skin cancer; however, patients with bone metastases and prostate cancer were significantly more likely to have received guideline-based care (RR = 2.0 and 1.1, respectively, p<0.05). For the aggregate of all cancers, the under-treatment rate significantly declined (p = 0.008) from 4% to 0% after the introduction of case rate payments, while the over-treatment rate remained steady at 9%, with no significant change (p = 0.20). These findings suggest that the introduction of case rate payments did not adversely affect the rate of guideline-based care at the provider examined. Additional research is needed to isolate the effect of the payment model and assess implications in other populations. PMID:26870963

  5. Do Case Rates Affect Physicians' Clinical Practice in Radiation Oncology?: An Observational Study.

    PubMed

    Loy, Bryan A; Shkedy, Clive I; Powell, Adam C; Happe, Laura E; Royalty, Julie A; Miao, Michael T; Smith, Gary L; Long, James W; Gupta, Amit K

    2016-01-01

    Case rate payments combined with utilization monitoring may have the potential to improve the quality of care by reducing over and under-treatment. Thus, a national managed care organization introduced case rate payments at one multi-site radiation oncology provider while maintaining only fee-for-service payments at others. This study examined whether the introduction of the payment method had an effect on radiation fractions administered when compared to clinical guidelines. The number of fractions of radiation therapy delivered to patients with bone metastases, breast, lung, prostate, and skin cancer was assessed for concordance with clinical guidelines. The proportion of guideline-based care ascertained from the payer's claims database was compared before (2011) and after (2013) the payment method introduction using relative risks (RR). After the introduction of case rates, there were no significant changes in guideline-based care in breast, lung, and skin cancer; however, patients with bone metastases and prostate cancer were significantly more likely to have received guideline-based care (RR = 2.0 and 1.1, respectively, p<0.05). For the aggregate of all cancers, the under-treatment rate significantly declined (p = 0.008) from 4% to 0% after the introduction of case rate payments, while the over-treatment rate remained steady at 9%, with no significant change (p = 0.20). These findings suggest that the introduction of case rate payments did not adversely affect the rate of guideline-based care at the provider examined. Additional research is needed to isolate the effect of the payment model and assess implications in other populations.

  6. Cost Utility Analysis of Cervical Therapeutic Medial Branch Blocks in Managing Chronic Neck Pain

    PubMed Central

    Manchikanti, Laxmaiah; Pampati, Vidyasagar; Kaye, Alan D.; Hirsch, Joshua A.

    2017-01-01

    Background:Controlled diagnostic studies have established the prevalence of cervical facet joint pain to range from 36% to 67% based on the criterion standard of ≥ 80% pain relief. Treatment of cervical facet joint pain has been described with Level II evidence of effectiveness for therapeutic facet joint nerve blocks and radiofrequency neurotomy and with no significant evidence for intraarticular injections. However, there have not been any cost effectiveness or cost utility analysis studies performed in managing chronic neck pain with or without headaches with cervical facet joint interventions. Study Design:Cost utility analysis based on the results of a double-blind, randomized, controlled trial of cervical therapeutic medial branch blocks in managing chronic neck pain. Objectives:To assess cost utility of therapeutic cervical medial branch blocks in managing chronic neck pain. Methods: A randomized trial was conducted in a specialty referral private practice interventional pain management center in the United States. This trial assessed the clinical effectiveness of therapeutic cervical medial branch blocks with or without steroids for an established diagnosis of cervical facet joint pain by means of controlled diagnostic blocks. Cost utility analysis was performed with direct payment data for the procedures for a total of 120 patients over a period of 2 years from this trial based on reimbursement rates of 2016. The payment data provided direct procedural costs without inclusion of drug treatments. An additional 40% was added to procedural costs with multiplication of a factor of 1.67 to provide estimated total costs including direct and indirect costs, based on highly regarded surgical literature. Outcome measures included significant improvement defined as at least a 50% improvement with reduction in pain and disability status with a combined 50% or more reduction in pain in Neck Disability Index (NDI) scores. Results:The results showed direct procedural costs per one-year improvement in quality adjusted life year (QALY) of United States Dollar (USD) of $2,552, and overall costs of USD $4,261. Overall, each patient on average received 5.7 ± 2.2 procedures over a period of 2 years. Average significant improvement per procedure was 15.6 ± 12.3 weeks and average significant improvement in 2 years per patient was 86.0 ± 24.6 weeks. Limitations:The limitations of this cost utility analysis are that data are based on a single center evaluation. Only costs of therapeutic interventional procedures and physician visits were included, with extrapolation of indirect costs. Conclusion:The cost utility analysis of therapeutic cervical medial branch blocks in the treatment of chronic neck pain non-responsive to conservative management demonstrated clinical effectiveness and cost utility at USD $4,261 per one year of QALY. PMID:29200944

  7. Cost Utility Analysis of Cervical Therapeutic Medial Branch Blocks in Managing Chronic Neck Pain.

    PubMed

    Manchikanti, Laxmaiah; Pampati, Vidyasagar; Kaye, Alan D; Hirsch, Joshua A

    2017-01-01

    Background: Controlled diagnostic studies have established the prevalence of cervical facet joint pain to range from 36% to 67% based on the criterion standard of ≥ 80% pain relief. Treatment of cervical facet joint pain has been described with Level II evidence of effectiveness for therapeutic facet joint nerve blocks and radiofrequency neurotomy and with no significant evidence for intraarticular injections. However, there have not been any cost effectiveness or cost utility analysis studies performed in managing chronic neck pain with or without headaches with cervical facet joint interventions. Study Design: Cost utility analysis based on the results of a double-blind, randomized, controlled trial of cervical therapeutic medial branch blocks in managing chronic neck pain. Objectives: To assess cost utility of therapeutic cervical medial branch blocks in managing chronic neck pain. Methods: A randomized trial was conducted in a specialty referral private practice interventional pain management center in the United States. This trial assessed the clinical effectiveness of therapeutic cervical medial branch blocks with or without steroids for an established diagnosis of cervical facet joint pain by means of controlled diagnostic blocks. Cost utility analysis was performed with direct payment data for the procedures for a total of 120 patients over a period of 2 years from this trial based on reimbursement rates of 2016. The payment data provided direct procedural costs without inclusion of drug treatments. An additional 40% was added to procedural costs with multiplication of a factor of 1.67 to provide estimated total costs including direct and indirect costs, based on highly regarded surgical literature. Outcome measures included significant improvement defined as at least a 50% improvement with reduction in pain and disability status with a combined 50% or more reduction in pain in Neck Disability Index (NDI) scores. Results: The results showed direct procedural costs per one-year improvement in quality adjusted life year (QALY) of United States Dollar (USD) of $2,552, and overall costs of USD $4,261. Overall, each patient on average received 5.7 ± 2.2 procedures over a period of 2 years. Average significant improvement per procedure was 15.6 ± 12.3 weeks and average significant improvement in 2 years per patient was 86.0 ± 24.6 weeks. Limitations: The limitations of this cost utility analysis are that data are based on a single center evaluation. Only costs of therapeutic interventional procedures and physician visits were included, with extrapolation of indirect costs. Conclusion: The cost utility analysis of therapeutic cervical medial branch blocks in the treatment of chronic neck pain non-responsive to conservative management demonstrated clinical effectiveness and cost utility at USD $4,261 per one year of QALY.

  8. 48 CFR 342.7003-2 - Procedures to be followed when withholding payments.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 48 Federal Acquisition Regulations System 4 2010-10-01 2010-10-01 false Procedures to be followed 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...

  9. 48 CFR 232.503-6 - Suspension or reduction of payments.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... also 242.7503. (g) Loss contracts. Use the following loss ratio adjustment procedures for making... subsection, the contracting officer must prepare a supplementary analysis of the contractor's request for progress payments and calculate the loss ratio adjustment using the procedures in FAR 32.503-6(g). (ii) The...

  10. 42 CFR 7.5 - Payment procedures.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... REFERENCE BIOLOGICAL STANDARDS AND BIOLOGICAL PREPARATIONS § 7.5 Payment procedures. An up-to-date fee..., Centers for Disease Control and Prevention, 1600 Clifton Road, MS C-17, Atlanta, Georgia 30333 or 404-639... in U.S. dollars at the time that the requester requests the biological reference standard or...

  11. 42 CFR 7.5 - Payment procedures.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... REFERENCE BIOLOGICAL STANDARDS AND BIOLOGICAL PREPARATIONS § 7.5 Payment procedures. An up-to-date fee..., Centers for Disease Control and Prevention, 1600 Clifton Road, MS C-17, Atlanta, Georgia 30333 or 404-639... in U.S. dollars at the time that the requester requests the biological reference standard or...

  12. 36 CFR 230.42 - Cost-share assistance application and payment procedures.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... service representative, existing landowner management plans such as Tree Farm management plans, Forest... 36 Parks, Forests, and Public Property 2 2014-07-01 2014-07-01 false Cost-share assistance application and payment procedures. 230.42 Section 230.42 Parks, Forests, and Public Property FOREST SERVICE...

  13. 36 CFR 230.42 - Cost-share assistance application and payment procedures.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... service representative, existing landowner management plans such as Tree Farm management plans, Forest... 36 Parks, Forests, and Public Property 2 2010-07-01 2010-07-01 false Cost-share assistance application and payment procedures. 230.42 Section 230.42 Parks, Forests, and Public Property FOREST SERVICE...

  14. 36 CFR 230.42 - Cost-share assistance application and payment procedures.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... service representative, existing landowner management plans such as Tree Farm management plans, Forest... 36 Parks, Forests, and Public Property 2 2011-07-01 2011-07-01 false Cost-share assistance application and payment procedures. 230.42 Section 230.42 Parks, Forests, and Public Property FOREST SERVICE...

  15. 36 CFR 230.42 - Cost-share assistance application and payment procedures.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... service representative, existing landowner management plans such as Tree Farm management plans, Forest... 36 Parks, Forests, and Public Property 2 2012-07-01 2012-07-01 false Cost-share assistance application and payment procedures. 230.42 Section 230.42 Parks, Forests, and Public Property FOREST SERVICE...

  16. 76 FR 70830 - Proposed Information Collection (Procedures, and Security for Government Financing) Activity...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-11-15

    ... (Procedures, and Security for Government Financing) Activity; Comment Request AGENCY: Office of Management... contract payments and to determine if the contractor has adequate security to warrant payment in advance... correspondence. During the comment period, comments may be viewed online through FDMS. FOR FURTHER INFORMATION...

  17. 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.

  18. The research on electronic commerce security payment system based on set protocol

    NASA Astrophysics Data System (ADS)

    Guo, Hongliang

    2012-04-01

    With the rapid development of network technology, online transactions have become more and more common. In this paper, we firstly introduce the principle and the basic principal and technical foundation of SET, and then we analyze the progress of designing a system in the foundation of the procedure of the electronic business based on SET. On this basis, we design a system of the Payment System for Electronic Business. It will not only take on crucial realism signification for large-scale, medium-sized and mini-type corporations, but also provide guide meaning with programmer and design-developer to realize Electronic Commerce (EC).

  19. 20 CFR 404.1825 - Joint payments to a family.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 20 Employees' Benefits 2 2011-04-01 2011-04-01 false Joint payments to a family. 404.1825 Section... INSURANCE (1950- ) Payment Procedures § 404.1825 Joint payments to a family. (a) Two or more beneficiaries in same family. If an amount is payable under title II of the Act for any month to two or more...

  20. 20 CFR 404.1825 - Joint payments to a family.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false Joint payments to a family. 404.1825 Section... INSURANCE (1950- ) Payment Procedures § 404.1825 Joint payments to a family. (a) Two or more beneficiaries in same family. If an amount is payable under title II of the Act for any month to two or more...

  1. 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...

  2. 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...

  3. 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...

  4. 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...

  5. Ambulatory surgery centers and interventional techniques: a look at long-term survival.

    PubMed

    Manchikanti, Laxmaiah; Parr, Allan T; Singh, Vijay; Fellows, Bert

    2011-01-01

    With health care expenditures skyrocketing, coupled with pervasive quality deficits, pressures to provide better and more proficient care continue to shape the landscape of the U.S. health care system. Payers, both federal and private, have laid out several initiatives designed to curtail costs, including value-based reimbursement programs, cost-shifting expenses to the consumer, reducing reimbursements for physicians, steering health care to more efficient settings, and finally affordable health care reform. Consequently, one of the major aspects in the expansion of health care for improving quality and reducing the costs is surgical services. Nearly 57 million outpatient procedures are performed annually in the United States, 14 million of which occur in elderly patients. Increasing use of these minor, yet common, procedures contributes to rising health care expenditures. Once exclusive within hospitals, more and more outpatient procedures are being performed in freestanding ambulatory surgery centers (ASCs), physician offices, visits to which have increased over 300% during the past decade. Concurrent with this growing demand, the number of ASCs has more than doubled since the 1990s, with more than 5,000 facilities currently in operation nationwide. Further, total surgical center ASC payments have increased from $1.2 billion in 1999 to $3.2 billion in 2009, a 167% increase. On the same lines, growth and expenditures for hospital outpatient department (HOPD) services and office procedures also have been evident at similar levels. Recent surveys have illustrated on overall annual growth per capita in Medicare allowed ASC services of pain management of 23%, with 27% growth seen in ASCs and 16% of the growth seen in HOPD. Further, the proportion of interventional pain management which was 4% of Medicare ASC spending in 2000 has increase to 10% in 2007. Thus, interventional pain management as an evolving specialty is one of the most commonly performed procedures in ASC settings apart from HOPDs and well-equipped offices. In June 1998, the Health Care Financing Administration (HCFA), proposed an ASC rule in which at least 60% of interventional procedures were eliminated from ASCs and the remaining 40% faced substantial cuts in payments. Following the publication of this rule, based on public comments and demand, Congress intervened and delayed implementation of the rule for several years. The Centers for Medicare and Medicaid Services (CMS) published its proposed outpatient prospective system for ASCs in 2006, setting ASC payments at 62% of HOPD payments. Following multiple changes, the rule was incorporated with a 4-year transition formula which ended in 2010, with full effect taking effect in 2011 with ASCs reimbursed at 57% of HOPD payments. Thus, the landscape of interventional pain management in ambulatory surgery centers has been constantly changing with declining reimbursements, issues of fraud and abuse, and ever-increasing regulations.

  6. [Effects of self-adapting G-DRG system 2004 to 2006 on in-patient services payment in pediatric hematology and oncology patients of a university hospital].

    PubMed

    Christaras, A; Schaper, J; Strelow, H; Laws, H-J; Göbel, U

    2006-01-01

    Reimbursement of inpatient treatment by daily constant charges is replaced by diagnosis- and procedure-related group system (G-DRG) in German acute care hospitals excerpt for psychiatry since 2004. Re-designs of G-DRG system were undertaken in 2005 and 2006. Parallel to implementation requirement- and resource-based self-adjustment of this new reimbursement system has been established by law. Adjustments performed in 2005 and 2006 are examined with respect to their effect on reimbursements in treatments of children with oncological, hematological, and immunological diseases. An unchanged population of 349 patients associated with 1,731 inpatient stays of a Clinic of Pediatric Oncology, Hematology, and Immunology in 2004 was analyzed by methods and means of G-DRG systems 2004, 2005, and 2006. DRGs and additional payments for drugs and procedures eligible for all and/or individual hospitals were calculated. G-DRG system 2005 resulted in overall reimbursement loss of 3.77 % compared to G-DRG 2004. G-DRG 2006 leads to slightly improved overall reimbursements compared to G-DRG 2005 by increasing DRG-based revenues. G-DRG 2006 effects 2.40 % reduction in overall reimbursement compared to G-DRG 2004. This loss includes ameliorating effects of additional payments for drugs and blood products already. Despite introduction of additional payments especially designed for children and teenagers in 2006, additional payment volume is decreased by 21.71 % from 2005 to 2006. G-DRG 2006 yields over-all reimbursement losses of 1.45 % in comparison to G-DRG 2004. Overall reimbursements include introduced additional payments for drugs and blood products. (Reimbursements resulting out of DRG payment alone drop by 14.73 % from 2004 to 2005, and increase by 3.26 % from 2005 to 2006 (2004 vs. 2006 11.95 %). Introduction of additional payments for drugs and blood products on a Germany-wide basis introduced in 2005 dampens DRG-based reimbursement losses. Despite introduction of dosage intervals specifically designed for children and adolescents in 2006, reimbursement of additional payments for drugs and blood products decrease by 21.71 % from 2005 to 2006. An important revenue-balancing function is attributed to additional charges individual for each hospital according to Par. 6 Section 2 (New diagnostic and therapeutic methods) and Section 2 a KHEntgG (German Hospital Reimbursement Law) with respect to financing tertiary care focusses. If possible to attain, those charges may partially equalize losses. Including these additional charges per individual hospital balance of summarized additional charges is -3.89 % from 2005 to 2006. However, fraction of additional payments on total reimbursements increases from 0.64 % in 2004 to 11.98 % in 2005, and 11.24 % in 2006, respectively. The G-DRG system in its versions 2005 and 2006 results in lowering overall reimbursements of a pediatric hematology, oncology, and immunology department compared to initial status in 2004. The growing chargeability of additional payments ameliorate this effect.

  7. American Medical Association

    MedlinePlus

    ... the Payment Process Physician Payment Resource Center Reinventing Medical Practice Managing Your Practice CPT® (Current Procedural Terminology) Medicare & Medicaid Private Payer Reform Claims Processing & Practice ...

  8. 46 CFR Sec. 9 - Payment.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 46 Shipping 8 2011-10-01 2011-10-01 false Payment. Sec. 9 Section 9 Shipping MARITIME ADMINISTRATION, DEPARTMENT OF TRANSPORTATION A-NATIONAL SHIPPING AUTHORITY PROCEDURE FOR ACCOMPLISHMENT OF VESSEL REPAIRS UNDER NATIONAL SHIPPING AUTHORITY MASTER LUMP SUM REPAIR CONTRACT-NSA-LUMPSUMREP Sec. 9 Payment...

  9. 46 CFR Sec. 9 - Payment.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 46 Shipping 8 2012-10-01 2012-10-01 false Payment. Sec. 9 Section 9 Shipping MARITIME ADMINISTRATION, DEPARTMENT OF TRANSPORTATION A-NATIONAL SHIPPING AUTHORITY PROCEDURE FOR ACCOMPLISHMENT OF VESSEL REPAIRS UNDER NATIONAL SHIPPING AUTHORITY MASTER LUMP SUM REPAIR CONTRACT-NSA-LUMPSUMREP Sec. 9 Payment...

  10. 46 CFR Sec. 9 - Payment.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 46 Shipping 8 2013-10-01 2013-10-01 false Payment. Sec. 9 Section 9 Shipping MARITIME ADMINISTRATION, DEPARTMENT OF TRANSPORTATION A-NATIONAL SHIPPING AUTHORITY PROCEDURE FOR ACCOMPLISHMENT OF VESSEL REPAIRS UNDER NATIONAL SHIPPING AUTHORITY MASTER LUMP SUM REPAIR CONTRACT-NSA-LUMPSUMREP Sec. 9 Payment...

  11. 46 CFR Sec. 9 - Payment.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 46 Shipping 8 2014-10-01 2014-10-01 false Payment. Sec. 9 Section 9 Shipping MARITIME ADMINISTRATION, DEPARTMENT OF TRANSPORTATION A-NATIONAL SHIPPING AUTHORITY PROCEDURE FOR ACCOMPLISHMENT OF VESSEL REPAIRS UNDER NATIONAL SHIPPING AUTHORITY MASTER LUMP SUM REPAIR CONTRACT-NSA-LUMPSUMREP Sec. 9 Payment...

  12. 46 CFR Sec. 9 - Payment.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 46 Shipping 8 2010-10-01 2010-10-01 false Payment. Sec. 9 Section 9 Shipping MARITIME ADMINISTRATION, DEPARTMENT OF TRANSPORTATION A-NATIONAL SHIPPING AUTHORITY PROCEDURE FOR ACCOMPLISHMENT OF VESSEL REPAIRS UNDER NATIONAL SHIPPING AUTHORITY MASTER LUMP SUM REPAIR CONTRACT-NSA-LUMPSUMREP Sec. 9 Payment...

  13. 14 CFR 15.115 - Payment.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 14 Aeronautics and Space 1 2011-01-01 2011-01-01 false Payment. 15.115 Section 15.115 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION PROCEDURAL RULES... the agreement to the United States Department of Justice and request payment, in accordance with the...

  14. 14 CFR 15.115 - Payment.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 14 Aeronautics and Space 1 2012-01-01 2012-01-01 false Payment. 15.115 Section 15.115 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION PROCEDURAL RULES... the agreement to the United States Department of Justice and request payment, in accordance with the...

  15. 14 CFR 15.115 - Payment.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 14 Aeronautics and Space 1 2010-01-01 2010-01-01 false Payment. 15.115 Section 15.115 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION PROCEDURAL RULES... the agreement to the United States Department of Justice and request payment, in accordance with the...

  16. 14 CFR 15.115 - Payment.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 14 Aeronautics and Space 1 2014-01-01 2014-01-01 false Payment. 15.115 Section 15.115 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION PROCEDURAL RULES... the agreement to the United States Department of Justice and request payment, in accordance with the...

  17. 14 CFR 15.115 - Payment.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 14 Aeronautics and Space 1 2013-01-01 2013-01-01 false Payment. 15.115 Section 15.115 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION PROCEDURAL RULES... the agreement to the United States Department of Justice and request payment, in accordance with the...

  18. Insurers' policies on coverage for behavior management services and the impact of the Affordable Care Act.

    PubMed

    Edelstein, Burton L

    2014-01-01

    The impact of the Affordable Care Act (ACA) on dental insurance coverage for behavior management services depends upon the child's source of insurance (Medicaid, CHIP, private commercial) and the policies that govern each such source. This contribution describes historical and projected sources of pediatric dental coverage, catalogues the seven behavior codes used by dentists, compares how often they are billed by pediatric and general dentists, assesses payment policies and practices for behavioral services across coverage sources, and describes how ACA coverage policies may impact each source. Differences between Congressional intent to ensure comprehensive oral health services with meaningful consumer protections for all legal-resident children and regulatory action by the Departments of Treasury and Health and Human Services are explored to explain how regulations fail to meet Congressional intent as of 2014. The ACA may additionally impact pediatric dentistry practice, including dentists' behavior management services, by expanding pediatric dental training and safety net delivery sites and by stimulating the evolution of novel payment and delivery systems designed to move provider incentives away from procedure-based payments and toward health outcome-based payments.

  19. Choosing Your Medical Specialty

    MedlinePlus

    ... the Payment Process Physician Payment Resource Center Reinventing Medical Practice Managing Your Practice CPT® (Current Procedural Terminology) Medicare & Medicaid Private Payer Reform Claims Processing & Practice ...

  20. 12 CFR 303.206 - Application for payment of principal or interest on subordinated debt.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 12 Banks and Banking 4 2010-01-01 2010-01-01 false Application for payment of principal or... CORPORATION PROCEDURE AND RULES OF PRACTICE FILING PROCEDURES Prompt Corrective Action § 303.206 Application... insured depository institution shall submit an application to pay principal or interest on subordinated...

  1. 24 CFR 17.159 - Application of offset funds: Federal payment is insufficient to cover amount of debt.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ...: Federal payment is insufficient to cover amount of debt. 17.159 Section 17.159 Housing and Urban... Procedures for the Collection of Claims by the Government Irs Tax Refund and Federal Payment Offset... insufficient to cover amount of debt. If an offset of a Federal payment is insufficient to satisfy a debt, the...

  2. 45 CFR 1801.52 - Payment schedule.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... Welfare Regulations Relating to Public Welfare (Continued) HARRY S. TRUMAN SCHOLARSHIP FOUNDATION HARRY S. TRUMAN SCHOLARSHIP PROGRAM Payment Conditions and Procedures § 1801.52 Payment schedule. The Foundation will pay the Scholar a portion of the award of the Scholarship stipend (as described in the Foundation...

  3. 45 CFR 1801.52 - Payment schedule.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... Welfare Regulations Relating to Public Welfare (Continued) HARRY S. TRUMAN SCHOLARSHIP FOUNDATION HARRY S. TRUMAN SCHOLARSHIP PROGRAM Payment Conditions and Procedures § 1801.52 Payment schedule. The Foundation will pay the Scholar a portion of the award of the Scholarship stipend (as described in the Foundation...

  4. 45 CFR 1801.52 - Payment schedule.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... Welfare Regulations Relating to Public Welfare (Continued) HARRY S. TRUMAN SCHOLARSHIP FOUNDATION HARRY S. TRUMAN SCHOLARSHIP PROGRAM Payment Conditions and Procedures § 1801.52 Payment schedule. The Foundation will pay the Scholar a portion of the award of the Scholarship stipend (as described in the Foundation...

  5. 45 CFR 1801.52 - Payment schedule.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... Welfare Regulations Relating to Public Welfare (Continued) HARRY S. TRUMAN SCHOLARSHIP FOUNDATION HARRY S. TRUMAN SCHOLARSHIP PROGRAM Payment Conditions and Procedures § 1801.52 Payment schedule. The Foundation will pay the Scholar a portion of the award of the Scholarship stipend (as described in the Foundation...

  6. 45 CFR 1801.52 - Payment schedule.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... Welfare Regulations Relating to Public Welfare (Continued) HARRY S. TRUMAN SCHOLARSHIP FOUNDATION HARRY S. TRUMAN SCHOLARSHIP PROGRAM Payment Conditions and Procedures § 1801.52 Payment schedule. The Foundation will pay the Scholar a portion of the award of the Scholarship stipend (as described in the Foundation...

  7. 12 CFR 1002.2 - Definitions.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... applicant to defer payment of a debt, incur debt and defer its payment, or purchase property or services and defer payment therefor. (k) Credit card means any card, plate, coupon book, or other single credit... demonstrates was not intentional and occurred notwithstanding the maintenance of procedures reasonably adapted...

  8. 12 CFR 1002.2 - Definitions.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... applicant to defer payment of a debt, incur debt and defer its payment, or purchase property or services and defer payment therefor. (k) Credit card means any card, plate, coupon book, or other single credit... demonstrates was not intentional and occurred notwithstanding the maintenance of procedures reasonably adapted...

  9. 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...

  10. 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...

  11. 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...

  12. 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...

  13. 14 CFR 151.129 - Payments.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... FEDERAL AID TO AIRPORTS Rules and Procedures for Advance Planning and Engineering Proposals § 151.129 Payments. (a) The United States' share of advance planning costs is paid in two installments unless the advance planning grant agreement provides otherwise. Upon request by sponsor, the first payment may be...

  14. Improving cardiovascular care through outpatient cardiac rehabilitation: an analysis of payment models that would improve quality and promote use.

    PubMed

    Mead, Holly; Grantham, Sarah; Siegel, Bruce

    2014-01-01

    Much attention has been paid to improving the care of patients with cardiovascular disease by focusing attention on delivery system redesign and payment reforms that encompass the healthcare spectrum, from an acute episode to maintenance of care. However, 1 area of cardiovascular disease care that has received little attention in the advancement of quality is cardiac rehabilitation (CR), a comprehensive secondary prevention program that is significantly underused despite evidence-based guidelines that recommending its use. The purpose of this article was to analyze the applicability of 2 payment and reimbursement models-pay-for-performance and bundled payments for episodes of care--that can promote the use of CR. We conclude that a payment model combining elements of both pay-for-performance and episodes of care would increase the use of CR, which would both improve quality and increase efficiency in cardiac care. Specific elements would need to be clearly defined, however, including: (a) how an episode is defined, (b) how to hold providers accountable for the care they provider, (c) how to encourage participation among CR providers, and (d) how to determine an equitable distribution of payment. Demonstrations testing new payment models must be implemented to generate empirical evidence that a melded pay-for-performance and episode-based care payment model will improve quality and efficiency.

  15. 32 CFR 32.22 - Payment.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ...-owned business enterprises, recipients shall be encouraged to use women-owned and minority-owned banks... ORGANIZATIONS Post-Award Requirements Financial and Program Management § 32.22 Payment. (a) Payment methods... Management Improvement Act (CMIA) (31 U.S.C. 3335 and 6503) or default procedures in 31 CFR part 205. (b...

  16. 29 CFR 2704.310 - Payment of award.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... Regulations Relating to Labor (Continued) FEDERAL MINE SAFETY AND HEALTH REVIEW COMMISSION IMPLEMENTATION OF THE EQUAL ACCESS TO JUSTICE ACT IN COMMISSION PROCEEDINGS Procedures for Considering Applications § 2704.310 Payment of award. Payment of awards made under the Equal Access to Justice Act by final orders...

  17. 29 CFR 100.616 - Payment collection.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 29 Labor 2 2010-07-01 2010-07-01 false Payment collection. 100.616 Section 100.616 Labor Regulations Relating to Labor NATIONAL LABOR RELATIONS BOARD ADMINISTRATIVE REGULATIONS Debt Collection Procedures § 100.616 Payment collection. (a) The NLRB shall make every effort to collect a claim in full...

  18. 30 CFR 220.031 - Reporting and payment requirements.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 30 Mineral Resources 2 2010-07-01 2010-07-01 false Reporting and payment requirements. 220.031 Section 220.031 Mineral Resources MINERALS MANAGEMENT SERVICE, DEPARTMENT OF THE INTERIOR MINERALS REVENUE MANAGEMENT ACCOUNTING PROCEDURES FOR DETERMINING NET PROFIT SHARE PAYMENT FOR OUTER CONTINENTAL SHELF OIL AND...

  19. 30 CFR 220.022 - Calculation of net profit share payment.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 30 Mineral Resources 2 2010-07-01 2010-07-01 false Calculation of net profit share payment. 220.022 Section 220.022 Mineral Resources MINERALS MANAGEMENT SERVICE, DEPARTMENT OF THE INTERIOR MINERALS REVENUE MANAGEMENT ACCOUNTING PROCEDURES FOR DETERMINING NET PROFIT SHARE PAYMENT FOR OUTER CONTINENTAL...

  20. 20 CFR 411.590 - What can an EN do if the EN disagrees with our decision on a payment request?

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... State VR agency has a payment dispute with us, the dispute shall be resolved under the dispute resolution procedures contained in the EN's agreement with us. (b) If a State VR agency serving a beneficiary as an EN has a dispute with us regarding payment under an EN payment system, the State VR agency may...

  1. 20 CFR 411.590 - What can an EN do if the EN disagrees with our decision on a payment request?

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... State VR agency has a payment dispute with us, the dispute shall be resolved under the dispute resolution procedures contained in the EN's agreement with us. (b) If a State VR agency serving a beneficiary as an EN has a dispute with us regarding payment under an EN payment system, the State VR agency may...

  2. 42 CFR 419.45 - Payment and copayment reduction for devices replaced without cost or when full or partial credit...

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... of reduction to the APC payment. (1) The amount of the reduction to the APC payment made under... be applied if the device implanted during a procedure assigned to the APC had transitional pass-through status under § 419.66. (2) The amount of the reduction to the APC payment made under paragraph (a...

  3. Possible consequences of regionally based bundled payments for diabetic amputations for safety net hospitals in Texas.

    PubMed

    Newhall, Karina; Stone, David; Svoboda, Ryan; Goodney, Philip

    2016-12-01

    Ongoing health reform in the United States encourages quality-based reimbursement methods such as bundled payments for surgery. The effect of such changes on high-risk procedures is unknown, especially at safety net hospitals. This study quantified the burden of diabetes-related amputation and the potential financial effect of bundled payments at safety net hospitals in Texas. We performed a cross-sectional analysis of diabetic amputation burden and charges using publically available data from Centers for Medicare and Medicaid and the Texas Department of Health from 2008 to 2012. Using hospital referral region (HRR)-level analysis, we categorized the proportion of safety net hospitals within each region as very low (0%-9%), low (10%-20%), average (20%-33%), and high (>33%) and compared amputation rates across regions using nonparametric tests of trend. We then used charge data to create reimbursement rates based on HRR to estimate financial losses. We identified 51 adult hospitals as safety nets in Texas. Regions varied in the proportion of safety net hospitals from 0% in Victoria to 65% in Harlingen. Among beneficiaries aged >65, amputation rates correlated to the proportion of safety net hospitals in each region; for example, patients in the lowest quartile of safety net had a yearly rate of 300 amputations per 100,000 beneficiaries, whereas those in the highest quartile had a yearly rate of 472 per 100,000 (P = .007). Charges for diabetic amputation-related admissions varied almost 200-fold, from $5000 to $1.4 million. Using reimbursement based on HRR to estimate a bundled payment, we noted net losses would be higher at safety net vs nonsafety net hospitals ($180 million vs $163 million), representing a per-hospital loss of $1.6 million at safety nets vs $700,000 at nonsafety nets (P < .001). Regions with a high proportion of safety net hospitals perform almost half of the diabetic amputations in Texas. Changes to traditional payment models should account for the disproportionate burden of high-risk procedures performed by these hospitals. Copyright © 2016. Published by Elsevier Inc.

  4. 34 CFR 1100.24 - What are the procedures for payment of a fellowship award directly to the fellow?

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 34 Education 3 2010-07-01 2010-07-01 false What are the procedures for payment of a fellowship award directly to the fellow? 1100.24 Section 1100.24 Education Regulations of the Offices of the Department of Education (Continued) NATIONAL INSTITUTE FOR LITERACY NATIONAL INSTITUTE FOR LITERACY: LITERACY...

  5. 34 CFR 1100.25 - What are the procedures for payment of a fellowship award through the fellow's employer?

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 34 Education 3 2010-07-01 2010-07-01 false What are the procedures for payment of a fellowship award through the fellow's employer? 1100.25 Section 1100.25 Education Regulations of the Offices of the Department of Education (Continued) NATIONAL INSTITUTE FOR LITERACY NATIONAL INSTITUTE FOR LITERACY: LITERACY...

  6. 76 FR 45814 - Animal Generic Drug User Fee Rates and Payment Procedures for Fiscal Year 2012

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-08-01

    ... DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and Drug Administration [Docket No. FDA-2011-N-0547] Animal Generic Drug User Fee Rates and Payment Procedures for Fiscal Year 2012 AGENCY: Food and Drug Administration, HHS. ACTION: Notice. SUMMARY: The Food and Drug Administration (FDA) is announcing the rates and...

  7. Optimizing claims payment for successful risk management.

    PubMed

    Frates, Janice; Ginty, Mary Jo; Baker, Linda

    2002-05-01

    Disputed claims and delayed payments are among the principal sources of provider and vendor dissatisfaction with managed care payment systems. Timely and accurate claims-payment systems are essential to ensure provider and vendor satisfaction, fiscal stability, and regulatory compliance. A focused analysis of conditions contributing to late payment of claims can disclose problems in provider, vendor, or payer operational and billing procedures, contracting processes, information systems, or human resources management. Resolution of these conditions equips claims-processing staff with tools to resolve problem claims promptly, thereby lowering costs.

  8. 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...

  9. 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...

  10. 46 CFR Sec. 4 - Method of payment.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 46 Shipping 8 2011-10-01 2011-10-01 false Method of payment. Sec. 4 Section 4 Shipping MARITIME ADMINISTRATION, DEPARTMENT OF TRANSPORTATION A-NATIONAL SHIPPING AUTHORITY PROCEDURE TO BE FOLLOWED BY GENERAL... Sec. 4 Method of payment. The General Agent shall prepare check drawn on the NSA Special bank account...

  11. 7 CFR 1427.15 - Special procedure where funds are advanced.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... collateral for a marketing assistance loan or to receive a loan deficiency payment. A person, firm, or... such person or firm is entitled to reimbursement from the proceeds of the marketing assistance loans or... deficiency payments; and (2) To marketing assistance loan or loan deficiency payment documents covering...

  12. 24 CFR 882.403 - ACC, housing assistance payments contract, and lease.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 24 Housing and Urban Development 4 2011-04-01 2011-04-01 false ACC, housing assistance payments... Procedures for Moderate Rehabilitation-Basic Policies § 882.403 ACC, housing assistance payments contract, and lease. (a) Maximum Total ACC Commitments. The maximum total annual contribution that may be...

  13. 12 CFR 202.2 - Definitions.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ...) Credit means the right granted by a creditor to an applicant to defer payment of a debt, incur debt and defer its payment, or purchase property or services and defer payment therefor. (k) Credit card means... notwithstanding the maintenance of procedures reasonably adapted to avoid such errors. (t) Judgmental system of...

  14. 12 CFR 202.2 - Definitions.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ...) Credit means the right granted by a creditor to an applicant to defer payment of a debt, incur debt and defer its payment, or purchase property or services and defer payment therefor. (k) Credit card means... notwithstanding the maintenance of procedures reasonably adapted to avoid such errors. (t) Judgmental system of...

  15. 12 CFR 202.2 - Definitions.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ...) Credit means the right granted by a creditor to an applicant to defer payment of a debt, incur debt and defer its payment, or purchase property or services and defer payment therefor. (k) Credit card means... notwithstanding the maintenance of procedures reasonably adapted to avoid such errors. (t) Judgmental system of...

  16. 3 CFR - Enhancing Payment Accuracy Through a “Do Not Pay List”

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... are not made. Agencies maintain many databases containing information on a recipient's eligibility to... databases before making payments or awards, agencies can identify ineligible recipients and prevent certain... pre-payment and pre-award procedures and ensure that a thorough review of available databases with...

  17. 49 CFR 107.616 - Payment procedures.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... Department's e-Commerce Internet site. Access to this service is provided at http://hazmat.dot.gov/regs...) must mail it to the same address or submit it through the same Internet site. (b) Payment must be made... payment acceptable to the Department on the registration statement or as part of an Internet registration...

  18. 20 CFR 422.303 - Interest, late payment penalties, and administrative costs of collection.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false Interest, late payment penalties, and administrative costs of collection. 422.303 Section 422.303 Employees' Benefits SOCIAL SECURITY ADMINISTRATION ORGANIZATION AND PROCEDURES Claims Collection § 422.303 Interest, late payment penalties, and administrative...

  19. 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...

  20. 20 CFR 411.595 - What oversight procedures are planned for the EN payment systems?

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... EN payment systems? 411.595 Section 411.595 Employees' Benefits SOCIAL SECURITY ADMINISTRATION THE TICKET TO WORK AND SELF-SUFFICIENCY PROGRAM Employment Network Payment Systems § 411.595 What oversight... activities to identify areas for improvement. Internal reviews of our systems security controls are regularly...

  1. 20 CFR 411.595 - What oversight procedures are planned for the EN payment systems?

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... EN payment systems? 411.595 Section 411.595 Employees' Benefits SOCIAL SECURITY ADMINISTRATION THE TICKET TO WORK AND SELF-SUFFICIENCY PROGRAM Employment Network Payment Systems § 411.595 What oversight... activities to identify areas for improvement. Internal reviews of our systems security controls are regularly...

  2. 20 CFR 411.595 - What oversight procedures are planned for the EN payment systems?

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... EN payment systems? 411.595 Section 411.595 Employees' Benefits SOCIAL SECURITY ADMINISTRATION THE TICKET TO WORK AND SELF-SUFFICIENCY PROGRAM Employment Network Payment Systems § 411.595 What oversight... activities to identify areas for improvement. Internal reviews of our systems security controls are regularly...

  3. 20 CFR 411.595 - What oversight procedures are planned for the EN payment systems?

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... EN payment systems? 411.595 Section 411.595 Employees' Benefits SOCIAL SECURITY ADMINISTRATION THE TICKET TO WORK AND SELF-SUFFICIENCY PROGRAM Employment Network Payment Systems § 411.595 What oversight... activities to identify areas for improvement. Internal reviews of our systems security controls are regularly...

  4. 20 CFR 411.595 - What oversight procedures are planned for the EN payment systems?

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... EN payment systems? 411.595 Section 411.595 Employees' Benefits SOCIAL SECURITY ADMINISTRATION THE TICKET TO WORK AND SELF-SUFFICIENCY PROGRAM Employment Network Payment Systems § 411.595 What oversight... activities to identify areas for improvement. Internal reviews of our systems security controls are regularly...

  5. Equity in Medicaid Reimbursement for Otolaryngologists.

    PubMed

    Conduff, Joseph H; Coelho, Daniel H

    2017-12-01

    Objective To study state Medicaid reimbursement rates for inpatient and outpatient otolaryngology services and to compare with federal Medicare benchmarks. Study Design State and federal database query. Setting Not applicable. Methods Based on Medicare claims data, 26 of the most common Current Procedural Terminology codes reimbursed to otolaryngologists were selected and the payments recorded. These were further divided into outpatient and operative services. Medicaid payment schemes were queried for the same services in 49 states and Washington, DC. The difference in Medicaid and Medicare payment in dollars and percentage was determined and the reimbursement per relative value unit calculated. Medicaid reimbursement differences (by dollar amount and by percentage) were qualified as a shortfall or excess as compared with the Medicare benchmark. Results Marked differences in Medicaid and Medicare reimbursement exist for all services provided by otolaryngologists, most commonly as a substantial shortfall. The Medicaid shortfall varied in amount among states, and great variability in reimbursement exists within and between operative and outpatient services. Operative services were more likely than outpatient services to have a greater Medicaid shortfall. Shortfalls and excesses were not consistent among procedures or states. Conclusions The variation in Medicaid payment models reflects marked differences in the value of the same work provided by otolaryngologists-in many cases, far less than federal benchmarks. These results question the fairness of the Medicaid reimbursement scheme in otolaryngology, with potential serious implications on access to care for this underserved patient population.

  6. 31 CFR 50.54 - Payment of Federal share of compensation.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 31 Money and Finance: Treasury 1 2014-07-01 2014-07-01 false Payment of Federal share of compensation. 50.54 Section 50.54 Money and Finance: Treasury Office of the Secretary of the Treasury TERRORISM RISK INSURANCE PROGRAM Claims Procedures § 50.54 Payment of Federal share of compensation. (a) Timing...

  7. 31 CFR 50.54 - Payment of Federal share of compensation.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 31 Money and Finance: Treasury 1 2012-07-01 2012-07-01 false Payment of Federal share of compensation. 50.54 Section 50.54 Money and Finance: Treasury Office of the Secretary of the Treasury TERRORISM RISK INSURANCE PROGRAM Claims Procedures § 50.54 Payment of Federal share of compensation. (a) Timing...

  8. 31 CFR 50.54 - Payment of Federal share of compensation.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 31 Money and Finance: Treasury 1 2011-07-01 2011-07-01 false Payment of Federal share of compensation. 50.54 Section 50.54 Money and Finance: Treasury Office of the Secretary of the Treasury TERRORISM RISK INSURANCE PROGRAM Claims Procedures § 50.54 Payment of Federal share of compensation. (a) Timing...

  9. 26 CFR 1.7519-2T - Required payments-procedures and administration (temporary).

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... payment under section 7519 for an applicable election year, the partnership or S corporation should type... termination of the section 444 election. (d) Negligence and fraud penalties made applicable. For purposes of section 6653, relating to additions to tax for negligence and fraud, any payment required by this section...

  10. 37 CFR 261.4 - Terms for making payment of royalty fees and statements of account.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... royalty fees and statements of account. 261.4 Section 261.4 Patents, Trademarks, and Copyrights COPYRIGHT OFFICE, LIBRARY OF CONGRESS COPYRIGHT ARBITRATION ROYALTY PANEL RULES AND PROCEDURES RATES AND TERMS FOR... payment of royalty fees and statements of account. (a) A Licensee shall make the royalty payments due...

  11. 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...

  12. 76 FR 37121 - Medicare Program; Second Semi-Annual Meeting of the Advisory Panel on Ambulatory Payment...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-06-24

    ... participate fully in the Panel's work. The expertise encompasses hospital payment systems; hospital medical care delivery systems; provider billing systems; APC groups; Current Procedural Terminology (CPT) codes... payment for, drugs, medical devices, and other services in the outpatient setting, as well as other forms...

  13. 75 FR 78246 - Medicare Program; Re-Chartering of the Advisory Panel on Ambulatory Payment Classification (APC...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-12-15

    ... Administrator among the fields of hospital payment systems; hospital medical care delivery systems; provider billing and accounting systems; APC groups; Current Procedural Terminology codes; HCPCS codes; the use of, and payment for, drugs, medical devices, and other services in the outpatient setting; and other forms...

  14. 29 CFR 2570.84 - Payment of civil penalty.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 29 Labor 9 2011-07-01 2011-07-01 false Payment of civil penalty. 2570.84 Section 2570.84 Labor... UNDER THE EMPLOYEE RETIREMENT INCOME SECURITY ACT Procedure for the Assessment of Civil Penalties Under ERISA Section 502(l) § 2570.84 Payment of civil penalty. (a) The civil penalty must be paid within 60...

  15. [Complex surgical procedures in orthopedics and trauma surgery. A contribution to the proposal procedure for the DRG system in 2009].

    PubMed

    Flohé, S; Nabring, J; Luetkes, P; Nast-Kolb, D; Windolf, J

    2008-10-01

    Since the DRG system was introduced in 2003/2004 the system for remuneration has been continually modified in conjunction with input from specialized medical associations. As part of this development of the payment system, the criteria for classification of a diagnosis-related group were further expanded and new functions were added. This contribution addresses the importance of the complex surgical procedures as criteria for subdivision of the DRG case-based lump sums in orthopedics and trauma surgery.

  16. 49 CFR 107.616 - Payment procedures.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    .... Box 530273, Atlanta, GA 30353-0273, or submit the statement and payment electronically through the... required fees for up to three registration years by filing one complete and accurate registration statement...

  17. 26 CFR 301.6163-1 - Extension of time for payment of estate tax on value of reversionary or remainder interest in...

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... value of reversionary or remainder interest in property. 301.6163-1 Section 301.6163-1 Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT OF THE TREASURY (CONTINUED) PROCEDURE AND ADMINISTRATION PROCEDURE AND ADMINISTRATION Time and Place for Paying Tax Place and Due Date for Payment of Tax § 301.6163-1 Extension of time...

  18. A Recursive Approach for Calculating the Effective Yield on Bonds when Settlement and/or Expected Maturity Is Other than an Interest Payment Date

    ERIC Educational Resources Information Center

    Vicknair, David; Downing, Ricard E.

    2007-01-01

    Standard spreadsheet functions cannot compute bond yields if both the settlement and maturity dates fall on other than an interest payment date. Using reciprocal cell references, the RATE function is enhanced to overcome this limitation. An appendix extends the enhancement procedure to the IRR function. The procedure demonstrated has applications…

  19. Annuity payments can increase patient access to innovative cell and gene therapies under England’s net budget impact test

    PubMed Central

    Jørgensen, Jesper; Kefalas, Panos

    2017-01-01

    ABSTRACT Background: Cell and gene therapies have the potential to provide therapeutic breakthroughs, but the high costs of researching, developing, manufacturing and delivering them translate into prices that may challenge healthcare budgets. Various measures exist that aim to address the affordability challenge, including reducing price, limiting patient numbers and/or linking remuneration to product performance. Objective: To explore how the net budget impact test recently introduced in England can affect patient access to high-value, one-off cell and gene therapies, and how managed entry agreements can improve access. Methods: We use a hypothetical example where a new high-value, one-off therapy launches in an indication where it displaces a relatively low cost chronic treatment. We calculate the number of patients that can be treated without exceeding the £20 million net budget impact threshold, and compare results for scenarios where a full upfront payment is used, and where annuity-based payments are used. Results: Charging a full upfront payment at the time of treatment can lead to suboptimal patient access. Conclusion: Annuity-based payments in combination with an outcomes-based remuneration scheme reduce consequences of decision uncertainty and can increase patient access, without exceeding the net budget impact test. PMID:28839525

  20. 17 CFR 300.400 - Satisfaction of customer claims for standardized options.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 17 Commodity and Securities Exchanges 3 2010-04-01 2010-04-01 false Satisfaction of customer... CORPORATION Closeout Or Completion of Open Contractual Commitments § 300.400 Satisfaction of customer claims... direct payment procedure pursuant to section 10 of the Act, in satisfaction of a claim based upon...

  1. 12 CFR 219.6 - Payment procedures.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... obtain payment and shall furnish an address for this purpose. (b) Special notice. If a grand jury or... jury or government authority shall promptly notify the financial institution of these facts, and shall...

  2. 42 CFR 7.5 - Payment procedures.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... obtain information on terms of payment and a fee schedule by writing the “Centers for Disease Control,” Financial Management Office, Buckhead Facility, Room 200, Centers for Disease Control, 1600 Clifton Road...

  3. 42 CFR 7.5 - Payment procedures.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... obtain information on terms of payment and a fee schedule by writing the “Centers for Disease Control,” Financial Management Office, Buckhead Facility, Room 200, Centers for Disease Control, 1600 Clifton Road...

  4. 18 CFR 11.20 - Time for payment.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 18 Conservation of Power and Water Resources 1 2010-04-01 2010-04-01 false Time for payment. 11.20... ACT General Procedures § 11.20 Time for payment. Annual charges must be paid no later than 45 days... with the Chief Financial Officer. No later than 30 days after the date of issuance of the Chief...

  5. 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...

  6. 36 CFR 1120.53 - Payment of fees.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... accordance with the procedures described in § 1120.51. Interest charges, computed at the rate prescribed in section 3717 of title 31 U.S.C.A., will be assessed on the full amount billed starting on the 31st day following the day on which the bill was sent. (c) Advance payment or assurance of payment. (1) When an ATBCB...

  7. 36 CFR 1120.53 - Payment of fees.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... accordance with the procedures described in § 1120.51. Interest charges, computed at the rate prescribed in section 3717 of title 31 U.S.C.A., will be assessed on the full amount billed starting on the 31st day following the day on which the bill was sent. (c) Advance payment or assurance of payment. (1) When an ATBCB...

  8. 22 CFR 221.23 - Payment to A.I.D. of excess amounts received by a Noteholder.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 22 Foreign Relations 1 2012-04-01 2012-04-01 false Payment to A.I.D. of excess amounts received by a Noteholder. 221.23 Section 221.23 Foreign Relations AGENCY FOR INTERNATIONAL DEVELOPMENT ISRAEL LOAN GUARANTEE STANDARD TERMS AND CONDITIONS Procedure for Obtaining Compensation § 221.23 Payment to A...

  9. 22 CFR 221.23 - Payment to A.I.D. of excess amounts received by a Noteholder.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 22 Foreign Relations 1 2011-04-01 2011-04-01 false Payment to A.I.D. of excess amounts received by a Noteholder. 221.23 Section 221.23 Foreign Relations AGENCY FOR INTERNATIONAL DEVELOPMENT ISRAEL LOAN GUARANTEE STANDARD TERMS AND CONDITIONS Procedure for Obtaining Compensation § 221.23 Payment to A...

  10. 22 CFR 221.23 - Payment to A.I.D. of excess amounts received by a Noteholder.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 22 Foreign Relations 1 2013-04-01 2013-04-01 false Payment to A.I.D. of excess amounts received by a Noteholder. 221.23 Section 221.23 Foreign Relations AGENCY FOR INTERNATIONAL DEVELOPMENT ISRAEL LOAN GUARANTEE STANDARD TERMS AND CONDITIONS Procedure for Obtaining Compensation § 221.23 Payment to A...

  11. 22 CFR 221.23 - Payment to A.I.D. of excess amounts received by a Noteholder.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 22 Foreign Relations 1 2014-04-01 2014-04-01 false Payment to A.I.D. of excess amounts received by a Noteholder. 221.23 Section 221.23 Foreign Relations AGENCY FOR INTERNATIONAL DEVELOPMENT ISRAEL LOAN GUARANTEE STANDARD TERMS AND CONDITIONS Procedure for Obtaining Compensation § 221.23 Payment to A...

  12. 22 CFR 221.23 - Payment to A.I.D. of excess amounts received by a Noteholder.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 22 Foreign Relations 1 2010-04-01 2010-04-01 false Payment to A.I.D. of excess amounts received by a Noteholder. 221.23 Section 221.23 Foreign Relations AGENCY FOR INTERNATIONAL DEVELOPMENT ISRAEL LOAN GUARANTEE STANDARD TERMS AND CONDITIONS Procedure for Obtaining Compensation § 221.23 Payment to A...

  13. 7 CFR 1430.208 - Payment rate and dairy operation payment.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... marketing order is below $16.94 per cwt. No payments will be made to dairy operations for marketings during...) Subtracting from $16.94 the Class I milk price per cwt. in Boston; (2) Multiplying the difference by 34... Feed Ration Cost per cwt. for each month will be calculated using the same procedures used to calculate...

  14. 7 CFR 1430.208 - Payment rate and dairy operation payment.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... marketing order is below $16.94 per cwt. No payments will be made to dairy operations for marketings during...) Subtracting from $16.94 the Class I milk price per cwt. in Boston; (2) Multiplying the difference by 34... Feed Ration Cost per cwt. for each month will be calculated using the same procedures used to calculate...

  15. 7 CFR 1430.208 - Payment rate and dairy operation payment.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... marketing order is below $16.94 per cwt. No payments will be made to dairy operations for marketings during...) Subtracting from $16.94 the Class I milk price per cwt. in Boston; (2) Multiplying the difference by 34... Feed Ration Cost per cwt. for each month will be calculated using the same procedures used to calculate...

  16. 12 CFR 625.29 - Payment of award.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... FCA will pay the amount awarded to the applicant within 60 days of receipt of the applicant's... EXPENSES UNDER THE EQUAL ACCESS TO JUSTICE ACT Procedures for Considering Applications § 625.29 Payment of...

  17. 12 CFR 313.53 - Non-waiver of rights by payments.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... PROCEDURES FOR CORPORATE DEBT COLLECTION Salary Offset § 313.53 Non-waiver of rights by payments. A debtor's... statute, regulation, or contract except as otherwise provided by law or contract. ...

  18. 40 CFR 610.14 - Payment of program costs.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... ECONOMY RETROFIT DEVICES Test Procedures and Evaluation Criteria General Provisions § 610.14 Payment of... request of a manufacturer of a retrofit device, should the Administrator test the device, or cause the...

  19. 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.

  20. 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

  1. How will provider-focused payment reform impact geographic variation in Medicare spending?

    PubMed

    Auerbach, David; Mehrotra, Ateev; Hussey, Peter; Huckfeldt, Peter J; Alpert, Abby; Lau, Christopher; Shier, Victoria

    2015-06-01

    The Institute of Medicine has recently argued against a value index as a mechanism to address geographic variation in spending and instead promoted payment reform targeted at individual providers. It is unknown whether such provider-focused payment reform reduces geographic variation in spending. We estimated the potential impact of 3 Medicare provider-focused payment policies-pay-for-performance, bundled payment, and accountable care organizations-on geographic variation in Medicare spending across Hospital Referral Regions (HRRs). We compared geographic variation in spending, measured using the coefficient of variation (CV) across HRRs, between the baseline case and a simulation of each of the 3 policies. Policy simulation based on 2008 national Medicare data combined with other publicly available data. Compared with the baseline (CV, 0.171), neither pay-for-performance nor accountable care organizations would change geographic variation in spending (CV, 0.171), while bundled payment would modestly reduce geographic variation (CV, 0.165). In our models, the bundled payment for inpatient and post acute care services in Medicare would modestly reduce geographic variation in spending, but neither accountable care organizations nor pay-for-performance appear to have an impact.

  2. 42 CFR 412.331 - Determining hospital-specific rates in cases of hospital merger, consolidation, or dissolution.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... each hospital's base period data, the intermediary determines a combined average discharge-weighted... payment determination: (1) Revised hospital-specific rate. Using each hospital's base period data, the... hospital-specific rates are determined as follows: (1) Hospital-specific rate—(i) Adequate base year data...

  3. 42 CFR 418.302 - Payment procedures for hospice care.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... individual who has elected hospice care receives general inpatient care in an inpatient facility for pain control or acute or chronic symptom management which cannot be managed in other settings. (c) The payment...

  4. 42 CFR 418.302 - Payment procedures for hospice care.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... individual who has elected hospice care receives general inpatient care in an inpatient facility for pain control or acute or chronic symptom management which cannot be managed in other settings. (c) The payment...

  5. 42 CFR 418.302 - Payment procedures for hospice care.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... individual who has elected hospice care receives general inpatient care in an inpatient facility for pain control or acute or chronic symptom management which cannot be managed in other settings. (c) The payment...

  6. 42 CFR 418.302 - Payment procedures for hospice care.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... individual who has elected hospice care receives general inpatient care in an inpatient facility for pain control or acute or chronic symptom management which cannot be managed in other settings. (c) The payment...

  7. 31 CFR 205.21 - When may clearance patterns be used?

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ...) FISCAL SERVICE, DEPARTMENT OF THE TREASURY FINANCIAL MANAGEMENT SERVICE RULES AND PROCEDURES FOR... of payment, such as payroll or vendor payments; or (5) Anything that is agreed upon by us and a State...

  8. 29 CFR 100.607 - Form of payment.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... § 100.607 Form of payment. These procedures are directed primarily at the recovery of money or, when a contractual basis exists, the NLRB may demand the return of specific property or the performance of specific...

  9. 36 CFR 1011.21 - How do other Federal agencies use the offset process to collect debts from payments issued by the...

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... use the offset process to collect debts from payments issued by the Presidio Trust? 1011.21 Section 1011.21 Parks, Forests, and Public Property PRESIDIO TRUST DEBT COLLECTION Procedures for Offset of Presidio Trust Payments To Collect Debts Owed To Other Federal Agencies § 1011.21 How do other Federal...

  10. 42 CFR 130.30 - Who may file a petition for payment or an amendment to a petition?

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 1 2010-10-01 2010-10-01 false Who may file a petition for payment or an amendment to a petition? 130.30 Section 130.30 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES COMPASSIONATE PAYMENTS RICKY RAY HEMOPHILIA RELIEF FUND PROGRAM Procedures for Filing and...

  11. Does Medical School Training Relate to Practice? Evidence from Big Data.

    PubMed

    Feldman, Keith; Chawla, Nitesh V

    2015-06-01

    On April 2nd, 2014, the Department of Health and Human Services (HHS) announced a historic policy in its effort to increase the transparency in the American healthcare system. The Center for Medicare and Medicaid Service (CMS) would publicly release a dataset containing information about the types of Medicare services, requested charges, and payments issued by providers across the country. In its release, HHS stated that the data would shed light on "Medicare fraud, waste, and abuse." While this is most certainly true, we believe that it can provide so much more. Beyond the purely financial aspects of procedure charges and payments, the procedures themselves may provide us with additional information, not only about the Medicare population, but also about the physicians themselves. The procedures a physician performs are for the most part not novel, but rather recommended, observed, and studied. However, whether a physician decides on advocating a procedure is somewhat discretionary. Some patients require a clear course of action, while others may benefit from a variety of options. This article poses the following question: How does a physician's past experience in medical school shape his or her practicing decisions? This article aims to open the analysis into how data, such as the CMS Medicare release, can help further our understanding of knowledge transfer and how experiences during education can shape a physician's decision's over the course of his or her career. This work begins with an evaluation into similarities between medical school charges, procedures, and payments. It then details how schools' procedure choices may link them in other, more interesting ways. Finally, the article includes a geographic analysis of how medical school procedure payments and charges are distributed nationally, highlighting potential deviations.

  12. Left ventricular assist device as destination therapy: application of the payment-by-results approach for the device reimbursement.

    PubMed

    Messori, Andrea; Trippoli, Sabrina; Bonacchi, Massimo; Sani, Guido

    2009-08-01

    Value-based methods are increasingly used to reimburse therapeutic innovation, and the payment-by-results approach has been proposed for handling interventions with limited therapeutic evidence. Because most left ventricular assist devices are supported by preliminary efficacy data, we examined the effectiveness data of the HeartMate (Thoratec Corp, Pleasanton, CA) device to explore the application of the payment-by-results approach to these devices and to develop a model for handling reimbursements. According to our model, after establishing the societal economic countervalue for each month of life saved, each patient treated with one such device is associated to the payment of this countervalue for every month of survival lived beyond the final date of estimated life expectancy without left ventricular assist devices. Our base-case analysis, which used the published data of 68 patients who received the HeartMate device, was run with a monthly countervalue of euro 5000, no adjustment for quality of life, and a baseline life expectancy of 150 days without left ventricular assist devices. Sensitivity analysis was aimed at testing the effect of quality of life adjustments and changes in life expectancy without device. In our base-case analysis, the mean total reimbursement per patient was euro 82,426 (range, euro 0 to euro 250,000; N = 68) generated as the sum of monthly payments. This average value was close to the current price of the HeartMate device (euro 75,000). Sensitivity testing showed that the base-case reimbursement of euro 82,426 was little influenced by variations in life expectancy, whereas variations in utility had a more pronounced impact. Our report delineates an innovative procedure for appropriately allocating economic resources in this area of invasive cardiology.

  13. 11 CFR 9033.10 - Procedures for initial and final determinations.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... when making an initial or final determination based on any of the following reasons. (1) The candidate... candidate's application for certification, as provided in 11 CFR 9033.3; (2) The candidate has failed to satisfy the matching payment threshold requirements, as provided in 11 CFR 9033.4; (3) The candidate is no...

  14. 5 CFR 9701.706 - MSPB appellate procedures.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... is based on a finding of discrimination prohibited under 5 U.S.C. 2302(b)(1), the payment of... discipline in the workplace, an arbitrator, adjudicating official, or MSPB may not modify the penalty imposed... allegations of discrimination, judicial review of any final MSPB order or decision is as prescribed under 5 U...

  15. 42 CFR 418.302 - Payment procedures for hospice care.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... brief periods of crisis as described in § 418.204(a) and only as necessary to maintain the terminally... control or acute or chronic symptom management which cannot be managed in other settings. (c) The payment...

  16. Compensating the transplant professional: time for a model change.

    PubMed

    Abouljoud, M; Whitehouse, S; Langnas, A; Brown, K

    2015-03-01

    Compensation models for physicians are currently based primarily on the work relative value unit (wRVU) that rewards productivity by work volume. The value-based payment structure soon to be ushered in by the Centers for Medicare and Medicaid Services rewards clinical quality and outcomes. This has prompted changes in wRVU value for certain services that will result in reduced payment for specialty procedures such as transplantation. To maintain a stable and competent workforce and achieve alignment between clinical activity, growth imperatives, and cost effectiveness, compensation of transplant physicians must evolve toward a matrix of measures beyond the procedure-based activity. This personal viewpoint proposes a redesign of transplant physician compensation plans to include the "virtual RVU" to recognize and reward meaningful clinical integration defined as hospital-physician commitment to specified and measurable metrics for current non-RVU-producing activities. Transplantation has been a leader in public outcomes reporting and is well suited to meet the challenges ahead that can only be overcome with a tight collaboration and alignment between surgeons, other physicians, support staff, and their respective institution and leadership. © Copyright 2015 The American Society of Transplantation and the American Society of Transplant Surgeons.

  17. 48 CFR 1552.232-74 - Payments-simplified acquisition procedures financing.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... acquisition procedures financing. 1552.232-74 Section 1552.232-74 Federal Acquisition Regulations System... Provisions and Clauses 1552.232-74 Payments—simplified acquisition procedures financing. As prescribed in... acquisition procedures financing. Payments—Simplified Acquisition Procedures Financing (JUN 2006) Simplified...

  18. Spinal surgery: variations in health care costs and implications for episode-based bundled payments.

    PubMed

    Ugiliweneza, Beatrice; Kong, Maiying; Nosova, Kristin; Huang, Kevin T; Babu, Ranjith; Lad, Shivanand P; Boakye, Maxwell

    2014-07-01

    Retrospective, observational. To simulate what episodes of care in spinal surgery might look like in a bundled payment system and to evaluate the associated costs and characteristics. Episode-based payment bundling has received considerable attention as a potential method to help curb the rise in health care spending and is being investigated as a new payment model as part of the Affordable Care Act. Although earlier studies investigated bundled payments in a number of surgical settings, very few focused on spine surgery, specifically. We analyzed data from MarketScan. Patients were included in the study if they underwent cervical or lumbar spinal surgery during 2000-2009, had at least 2-year preoperative and 90-day postoperative follow-up data. Patients were grouped on the basis of their diagnosis-related group (DRG) and then tracked in simulated episodes-of-care/payment bundles that lasted for the duration of 30, 60, and 90 days after the discharge from the index-surgical hospitalization. The total cost associated with each episode-of-care duration was measured and characterized. A total of 196,918 patients met our inclusion criteria. Significant variation existed between DRGs, ranging from $11,180 (30-day bundle, DRG 491) to $107,642 (30-day bundle, DRG 456). There were significant cost variations within each individual DRG. Postdischarge care accounted for a relatively small portion of overall bundle costs (range, 4%-8% in 90-day bundles). Total bundle costs remained relatively flat as bundle-length increased (total average cost of 30-day bundle: $33,522 vs. $35,165 for 90-day bundle). Payments to hospitals accounted for the largest portion of bundle costs (76%). There exists significant variation in total health care costs for patients who undergo spinal surgery, even within a given DRG. Better characterization of impacts of a bundled payment system in spine surgery is important for understanding the costs of index procedure hospital, physician services, and postoperative care on potential future health care policy decision making. N/A.

  19. Informal cash payments for birth in Hungary: Are women paying to secure a known provider, respect, or quality of care?

    PubMed

    Baji, Petra; Rubashkin, Nicholas; Szebik, Imre; Stoll, Kathrin; Vedam, Saraswathi

    2017-09-01

    In Central and Eastern Europe, many women make informal cash payments to ensure continuity of provider, i.e., to have a "chosen" doctor who provided their prenatal care, be present for birth. High rates of obstetric interventions and disrespectful maternity care are also common to the region. No previous study has examined the associations among informal payments, intervention rates, and quality of maternity care. We distributed an online cross-sectional survey in 2014 to a nationally representative sample of Hungarian internet-using women (N = 600) who had given birth in the last 5 years. The survey included items related to socio-demographics, type of provider, obstetric interventions, and experiences of care. Women reported if they paid informally, and how much. We built a two-part model, where a bivariate probit model was used to estimate conditional probabilities of women paying informally, and a GLM model to explore the amount of payments. We calculated marginal effects of the covariates (provider choice, interventions, respectful care). Many more women (79%) with a chosen doctor paid informally (191 euros on average) compared to 17% of women without a chosen doctor (86 euros). Based on regression analysis, the chosen doctor's presence at birth was the principal determinant of payment. Intervention and procedure rates were significantly higher for women with a chosen doctor versus without (cesareans 45% vs. 33%; inductions 32% vs. 19%; episiotomy 75% vs. 62%; epidural 13% vs. 5%), but had no direct effect on payments. Half of the sample (42% with a chosen doctor, 62% without) reported some form of disrespectful care, but this did not reduce payments. Despite reporting disrespect and higher rates of interventions, women rewarded the presence of a chosen doctor with informal payments. They may be unaware of evidence-based standards, and trust that their chosen doctor provided high quality maternity care. Copyright © 2017 Elsevier Ltd. All rights reserved.

  20. Cost Transparency in Neurosurgery: A Single-Institution Analysis of Patient Out-of-Pocket Spending in 13 673 Consecutive Neurosurgery Cases.

    PubMed

    Mooney, Michael A; Yoon, Seungwon; Cole, Tyler; Sheehy, John P; Bohl, Michael A; Barranco, F David; Nakaji, Peter; Little, Andrew S; Lawton, Michael T

    2018-05-15

    Patient out-of-pocket (OOP) spending is an increasingly discussed topic; however, there is minimal data available on the patient financial burden of surgical procedures. To analyze hospital and surgeon expected payment data and patient OOP spending in neurosurgery. This is a retrospective cohort study of neurosurgical patients at a tertiary-referral center from 2013 to 2016. Expected payments, reflecting negotiated costs-of-care, as well as actual patient OOP payments for hospital care and surgeon professional fees were analyzed. A 4-tiered model of patient OOP cost sharing and a multivariate model of patient expected payments were created. A total of 13 673 consecutive neurosurgical cases were analyzed. Patient age, insurance type, case category, severity of illness, length of stay (LOS), and elective case status were significant predictors of increased expected payments (P < .05). Craniotomy ($53 397 ± 811) and posterior spinal fusion ($48 329 ± 864) were associated with the highest expected payments. In a model of patient OOP cost sharing, nearly all neurosurgical procedures exceeded yearly OOP maximums for Healthcare Marketplace plans. Mean patient payments for hospital care and surgeon professional fees were the highest for anterior/lateral spinal fusion cases for commercially insured patients ($1662 ± 165). Mean expected payments and mean patient payments for commercially insured patients increased significantly from 2013 to 2016 (P < .05). Expected payments and patient OOP spending for commercially insured patients significantly increased from 2013 to 2016, representing increased healthcare costs and patient cost sharing in an evolving healthcare environment. Patients and providers can consider this information prior to surgery to better anticipate the individual financial burden for neurosurgical care.

  1. Support for All in the UK Work Programme? Differential Payments, Same Old Problem

    PubMed Central

    Rees, James; Whitworth, Adam; Carter, Elle

    2014-01-01

    The UK has been a high profile policy innovator in welfare-to-work provision which has led in the Coalition government's Work Programme to a fully outsourced, ‘black box’ model with payments based overwhelmingly on job outcome results. A perennial fear in such programmes is providers' incentives to ‘cream’ and ‘park’ claimants, and the Department for Work and Pensions has sought to mitigate such provider behaviours through Work Programme design, particularly via the use of claimant groups and differential pricing. In this article, we draw on a qualitative study of providers in the programme alongside quantitative analysis of published performance data to explore evidence around creaming and parking. The combination of the quantitative and qualitative evidence suggest that creaming and parking are widespread, seem systematically embedded within the Work Programme, and are driven by a combination of intense cost-pressures and extremely ambitious performance targets alongside overly diverse claimant groups and inadequately calibrated differentiated payment levels. PMID:25411516

  2. A Novel Image Steganography Technique for Secured Online Transaction Using DWT and Visual Cryptography

    NASA Astrophysics Data System (ADS)

    Anitha Devi, M. D.; ShivaKumar, K. B.

    2017-08-01

    Online payment eco system is the main target especially for cyber frauds. Therefore end to end encryption is very much needed in order to maintain the integrity of secret information related to transactions carried online. With access to payment related sensitive information, which enables lot of money transactions every day, the payment infrastructure is a major target for hackers. The proposed system highlights, an ideal approach for secure online transaction for fund transfer with a unique combination of visual cryptography and Haar based discrete wavelet transform steganography technique. This combination of data hiding technique reduces the amount of information shared between consumer and online merchant needed for successful online transaction along with providing enhanced security to customer’s account details and thereby increasing customer’s confidence preventing “Identity theft” and “Phishing”. To evaluate the effectiveness of proposed algorithm Root mean square error, Peak signal to noise ratio have been used as evaluation parameters

  3. Support for All in the UK Work Programme? Differential Payments, Same Old Problem.

    PubMed

    Rees, James; Whitworth, Adam; Carter, Elle

    2014-04-01

    The UK has been a high profile policy innovator in welfare-to-work provision which has led in the Coalition government's Work Programme to a fully outsourced, 'black box' model with payments based overwhelmingly on job outcome results. A perennial fear in such programmes is providers' incentives to 'cream' and 'park' claimants, and the Department for Work and Pensions has sought to mitigate such provider behaviours through Work Programme design, particularly via the use of claimant groups and differential pricing. In this article, we draw on a qualitative study of providers in the programme alongside quantitative analysis of published performance data to explore evidence around creaming and parking. The combination of the quantitative and qualitative evidence suggest that creaming and parking are widespread, seem systematically embedded within the Work Programme, and are driven by a combination of intense cost-pressures and extremely ambitious performance targets alongside overly diverse claimant groups and inadequately calibrated differentiated payment levels.

  4. 20 CFR 416.2098 - Supplementary payment levels.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false Supplementary payment levels. 416.2098... Supplementary payment levels. (a) General. For the purpose of determining the combined supplementary/SSI payment levels described in § 416.2097(a) (i.e., the levels that must be provided in any month after March 1983...

  5. 12 CFR 313.24 - Omission of procedures.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... recoupment (i.e., the FDIC may offset a payment due to the debtor when both the payment due to the debtor and... administrative offsets, the FDIC first learns of the existence of a debt due when there would be insufficient...

  6. 12 CFR 313.24 - Omission of procedures.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... recoupment (i.e., the FDIC may offset a payment due to the debtor when both the payment due to the debtor and... administrative offsets, the FDIC first learns of the existence of a debt due when there would be insufficient...

  7. 45 CFR 5.44 - Procedures for assessing and collecting fees.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... proceed with the search. (b) Advance payment. If you have failed to pay previous bills in a timely fashion... have a history of prompt payment. We may also, at our discretion, aggregate the charges for certain...

  8. Optimizing revenue at a cosmetic surgery centre

    PubMed Central

    Funk, Joanna M; Verheyden, Charles N; Mahabir, Raman C

    2011-01-01

    BACKGROUND: The demand for cosmetic surgery and services has diminished with recent fluctuations in the economy. To stay ahead, surgeons must appreciate and attend to the fiscal challenges of private practice. A key component of practice economics is knowledge of the common methods of payment. OBJECTIVE: To review methods of payment in a five-surgeon group practice in central Texas, USA. METHODS: A retrospective chart review of the financial records of a cosmetic surgery centre in Texas was conducted. Data were collected for the five-year period from 2003 to 2008, and included the method of payment, the item purchased (product, service or surgery) and the dollar amount. RESULTS: More than 11,000 transactions were reviewed. The most common method of payment used for products and services was credit card, followed by check and cash. For procedures, the most common form of payment was personal check, followed by credit card and financing. Of the credit card purchases for both products and procedures, an overwhelming majority of patients (more than 75%) used either Visa (Visa Inc, USA) or MasterCard (MasterCard Worldwide, USA). If the amount of the individual transaction surpassed US$1,000, the most common method of payment transitioned from credit card to personal check. CONCLUSIONS: In an effort to maximize revenue, surgeons should consider limiting the credit cards accepted by the practice and encourage payment through personal check. PMID:22942656

  9. Optimizing revenue at a cosmetic surgery centre.

    PubMed

    Funk, Joanna M; Verheyden, Charles N; Mahabir, Raman C

    2011-01-01

    The demand for cosmetic surgery and services has diminished with recent fluctuations in the economy. To stay ahead, surgeons must appreciate and attend to the fiscal challenges of private practice. A key component of practice economics is knowledge of the common methods of payment. To review methods of payment in a five-surgeon group practice in central Texas, USA. A retrospective chart review of the financial records of a cosmetic surgery centre in Texas was conducted. Data were collected for the five-year period from 2003 to 2008, and included the method of payment, the item purchased (product, service or surgery) and the dollar amount. More than 11,000 transactions were reviewed. The most common method of payment used for products and services was credit card, followed by check and cash. For procedures, the most common form of payment was personal check, followed by credit card and financing. Of the credit card purchases for both products and procedures, an overwhelming majority of patients (more than 75%) used either Visa (Visa Inc, USA) or MasterCard (MasterCard Worldwide, USA). If the amount of the individual transaction surpassed US$1,000, the most common method of payment transitioned from credit card to personal check. In an effort to maximize revenue, surgeons should consider limiting the credit cards accepted by the practice and encourage payment through personal check.

  10. Merit-Based Incentive Payment System (MIPS): Harsh Choices For Interventional Pain Management Physicians.

    PubMed

    Manchikanti, Laxmaiah; Helm Ii, Standiford; Benyamin, Ramsin M; Hirsch, Joshua A

    2016-01-01

    The Merit-based Incentive Payment System (MIPS) was created by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) to improve the health of all Americans by providing incentives and policies to improve patient health outcomes. MIPS combines 3 existing programs, Meaningful Use (MU), now called Advancing Care Information (ACI), contributing 25% of the composite score; Physician Quality Reporting System (PQRS), changed to Quality, contributing 50% of the composite score; and Value-based Payment (VBP) system to Resource Use or cost, contributing 10% of the composite score. Additionally, Clinical Practice Improvement Activities (CPIA), contributing 15% of the composite score, create multiple strategic goals to design incentives that drive movement toward delivery system reform principles with inclusion of Advanced Alternative Payment Models (APMs). Under the present proposal, the Centers for Medicare and Medicaid Services (CMS) has estimated approximately 30,000 to 90,000 providers from a total of over 761,000 providers will be exempt from MIPS. About 87% of solo practitioners and 70% of practitioners in groups of less than 10 will be subjected to negative payments or penalties ranging from 4% to 9%. In addition, MIPS also will affect a provider's reputation by making performance measures accessible to consumers and third-party physician rating Web sites.The MIPS composite performance scoring method, at least in theory, utilizes weights for each performance category, exceptional performance factors to earn bonuses, and incorporates the special circumstances of small practices.In conclusion, MIPS has the potential to affect practitioners negatively. Interventional Pain Medicine practitioners must understand the various MIPS measures and how they might participate in order to secure a brighter future. Medicare Access and CHIP Reauthorization Act of 2015, merit-based incentive payment system, quality performance measures, resource use, clinical practice improvement activities, advancing care information performance category.

  11. Refining Risk Adjustment for the Proposed CMS Surgical Hip and Femur Fracture Treatment Bundled Payment Program.

    PubMed

    Cairns, Mark A; Ostrum, Robert F; Clement, R Carter

    2018-02-21

    The U.S. Centers for Medicare & Medicaid Services (CMS) has been considering the implementation of a mandatory bundled payment program, the Surgical Hip and Femur Fracture Treatment (SHFFT) model. However, bundled payments without appropriate risk adjustment may be inequitable to providers and may restrict access to care for certain patients. The SHFFT proposal includes adjustment using the Diagnosis-Related Group (DRG) and geographic location. The goal of the current study was to identify and quantify patient factors that could improve risk adjustment for SHFFT bundled payments. We retrospectively reviewed a 5% random sample of Medicare data from 2008 to 2012. A total of 27,898 patients were identified who met SHFFT inclusion criteria (DRG 480, 481, and 482). Reimbursement was determined for each patient over the bundle period (the surgical hospitalization and 90 days of post-discharge care). Multivariable regression was performed to test demographic factors, comorbidities, geographic location, and specific surgical procedures for associations with reimbursement. The average reimbursement was $23,632 ± $17,587. On average, reimbursements for male patients were $1,213 higher than for female patients (p < 0.01). Younger age was also associated with higher payments; e.g., reimbursement for those ≥85 years of age averaged $2,282 ± $389 less than for those aged 65 to 69 (p < 0.01). Most comorbidities were associated with higher reimbursement, but dementia was associated with lower payments, by an average of $2,354 ± $243 (p < 0.01). Twenty-two procedure codes are included in the bundle, and patients with the 3 most common codes accounted for 98% of the cases, with average reimbursement ranging from $22,527 to $24,033. Less common procedures varied by >$20,000 in average reimbursement (p < 0.01). DRGs also showed significant differences in reimbursement (p < 0.01); e.g., DRG 480 was reimbursed by an average of $10,421 ± $543 more than DRG 482. Payments varied significantly by state (p ≤ 0.01). Risk adjustment incorporating specific comorbidities demonstrated better performance than with use of DRG alone (r = 0.22 versus 0.15). Our results suggest that the proposed SHFFT bundled payment model should use more robust risk-adjustment methods to ensure that providers are reimbursed fairly and that patients retain access to care. At a minimum, payments should be adjusted for age, comorbidities, demographic factors, geographic location, and surgical procedure.

  12. Financial analysis of technology acquisition using fractionated lasers as a model.

    PubMed

    Jutkowitz, Eric; Carniol, Paul J; Carniol, Alan R

    2010-08-01

    Ablative fractional lasers are among the most advanced and costly devices on the market. Yet, there is a dearth of published literature on the cost and potential return on investment (ROI) of such devices. The objective of this study was to provide a methodological framework for physicians to evaluate ROI. To facilitate this analysis, we conducted a case study on the potential ROI of eight ablative fractional lasers. In the base case analysis, a 5-year lease and a 3-year lease were assumed as the purchase option with a $0 down payment and 3-month payment deferral. In addition to lease payments, service contracts, labor cost, and disposables were included in the total cost estimate. Revenue was estimated as price per procedure multiplied by total number of procedures in a year. Sensitivity analyses were performed to account for variability in model assumptions. Based on the assumptions of the model, all lasers had higher ROI under the 5-year lease agreement compared with that for the 3-year lease agreement. When comparing results between lasers, those with lower operating and purchase cost delivered a higher ROI. Sensitivity analysis indicates the model is most sensitive to purchase method. If physicians opt to purchase the device rather than lease, they can significantly enhance ROI. ROI analysis is an important tool for physicians who are considering making an expensive device acquisition. However, physicians should not rely solely on ROI and must also consider the clinical benefits of a laser. (c) Thieme Medical Publishers.

  13. Medicare payments for noninvasive diagnostic imaging are now higher to nonradiologist physicians than to radiologists.

    PubMed

    Levin, David C; Rao, Vijay M; Parker, Laurence; Frangos, Andrea J; Sunshine, Jonathan H

    2011-01-01

    Radiologists have always been considered the physicians who "control" noninvasive diagnostic imaging (NDI) and are primarily responsible for its growth. Yet nonradiologists have become increasingly aggressive in their performance and interpretation of imaging. The purpose of this study was to track overall Medicare payments to radiologists and nonradiologist physicians in recent years. The Medicare Part B files covering all fee-for-service physician payments for 1998 to 2008 were the data source. All codes for discretionary NDI were selected. Procedures mandated by the patient's clinical condition (eg, supervision and interpretation codes for interventional procedures, radiation therapy planning) were excluded, as were nonimaging radionuclide tests. Medicare physician specialty codes were used to identify radiologists and nonradiologists. Payments in all places of service were included. Overall Medicare NDI payments to radiologists and nonradiologist physicians from 1998 through 2008 were compared. A separate analysis of NDI payments to cardiologists was conducted, because next to radiologists, they are the highest users of imaging. In 1998, overall Part B payments to radiologists for discretionary NDI were $2.563 billion, compared with $2.020 billion to nonradiologists (ie, radiologists' payments were 27% higher). From 1998 to 2006, payments to nonradiologists increased by 166%, compared with 107% to radiologists. By 2006, payments to nonradiologists exceeded those to radiologists. By 2008, the second year after implementation of the Deficit Reduction Act, payments to radiologists had dropped by 13%, compared with 11% to nonradiologists. In 2008, nonradiologists received $4.807 billion for discretionary NDI, and radiologists received $4.638 billion. Payments to cardiologists for NDI increased by 195% from 1998 to 2006, then dropped by 8% by 2008. The growth in fee-for-service payments to nonradiologists for NDI was considerably more rapid than the growth for radiologists between 1998 and 2006. Then, by the end of 2008, 2 years after the implementation of the Deficit Reduction Act, steeper revenue losses had been experienced by radiologists. The result was that by 2008, overall Medicare fee-for-service payments for NDI were 4% higher to nonradiologists than they were to radiologists. Copyright © 2011 American College of Radiology. Published by Elsevier Inc. All rights reserved.

  14. 20 CFR 416.2098 - Supplementary payment levels.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... payment. +9.70 July 1983 COLA-equivalent. 529.10 Required July 1983 combined payment level. 529.10... amount for a 31-day month plus the July 1983 COLA-equivalent ($519.40 + $9.70). (f) Required optional...

  15. 20 CFR 416.2098 - Supplementary payment levels.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... payment. +9.70 July 1983 COLA-equivalent. 529.10 Required July 1983 combined payment level. 529.10... amount for a 31-day month plus the July 1983 COLA-equivalent ($519.40 + $9.70). (f) Required optional...

  16. 20 CFR 416.2098 - Supplementary payment levels.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... payment. +9.70 July 1983 COLA-equivalent. 529.10 Required July 1983 combined payment level. 529.10... amount for a 31-day month plus the July 1983 COLA-equivalent ($519.40 + $9.70). (f) Required optional...

  17. 20 CFR 416.2098 - Supplementary payment levels.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... payment. +9.70 July 1983 COLA-equivalent. 529.10 Required July 1983 combined payment level. 529.10... amount for a 31-day month plus the July 1983 COLA-equivalent ($519.40 + $9.70). (f) Required optional...

  18. Exploring consumers’ attitudes towards informal patient payments using the combined method of cluster and multinomial regression analysis - the case of Hungary

    PubMed Central

    2013-01-01

    Background Previous studies on informal patient payments have mostly focused on the magnitude and determinants of these payments while the attitudes of health care actors towards these payments are less well known. This study aims to reveal the attitudes of Hungarian health care consumers towards informal payments to provide a better understanding of this phenomenon. Methods For the analysis, we use data from a survey carried out in 2010 in Hungary involving a representative sample of 1037 respondents. We use cluster analysis to identify the main attitude groups related to informal payments based on the respondents’ perception of and behavior related to informal payments. Multinomial logistic regression is applied to examine the differences between these groups in terms of socio-demographic characteristics, as well as past utilization and informal payments paid for health care services. Results We identified three main different attitudes towards informal payments: accepting informal payments, doubting about informal payments and opposing informal payments. Those who accept informal payments (mostly young or elderly people, living in the capital) consider these payments as an expression of gratitude and perceive them as inevitable due to the low funding of the health care system. Those who doubt about informal payments (mostly respondents outside the capital, with higher education and higher household income) are not certain whether these payments are inevitable, perceive them as similar to corruption rather than gratitude, and would rather use private services to avoid these payments. We find that the opposition to informal payments (mostly among men from small households and low income households) can be explained by their lower ability and willingness to pay. Conclusions A large share of Hungarian health care consumers has a rather positive attitude towards informal payments, perceiving them as “inevitable due to the low funding of the health care system”. From a policy point-of-view, the change of this consumer attitude will be essential to deal with these payments in addition to other policy strategies. PMID:23414488

  19. Provider payment methods and health worker motivation in community-based health insurance: a mixed-methods study.

    PubMed

    Robyn, Paul Jacob; Bärnighausen, Till; Souares, Aurélia; Traoré, Adama; Bicaba, Brice; Sié, Ali; Sauerborn, Rainer

    2014-05-01

    In a community-based health insurance (CBHI) introduced in 2004 in Nouna health district, Burkina Faso, poor perceived quality of care by CBHI enrollees has been a key factor in observed high drop-out rates. The poor quality perceptions have been previously attributed to health worker dissatisfaction with the provider payment method used by the scheme and the resulting financial risk of health centers. This study applied a mixed-methods approach to investigate how health workers working in facilities contracted by the CBHI view the methods of provider payment used by the CBHI. In order to analyze these relationships, we conducted 23 in-depth interviews and a quantitative survey with 98 health workers working in the CBHI intervention zone. The qualitative in-depth interviews identified that insufficient levels of capitation payments, the infrequent schedule of capitation payment, and lack of a payment mechanism for reimbursing service fees were perceived as significant sources of health worker dissatisfaction and loss of work-related motivation. Combining qualitative interview and quantitative survey data in a mixed-methods analysis, this study identified that the declining quality of care due to the CBHI provider payment method was a source of significant professional stress and role strain for health workers. Health workers felt that the following five changes due to the provider payment methods introduced by the CBHI impeded their ability to fulfill professional roles and responsibilities: (i) increased financial volatility of health facilities, (ii) dissatisfaction with eligible costs to be covered by capitation; (iii) increased pharmacy stock-outs; (iv) limited financial and material support from the CBHI; and (v) the lack of mechanisms to increase provider motivation to support the CBHI. To address these challenges and improve CBHI uptake and health outcomes in the targeted populations, the health care financing and delivery model in the study zone should be reformed. We discuss concrete options for reform based on the study findings. Copyright © 2014 Elsevier Ltd. All rights reserved.

  20. 7 CFR 14.5 - Procedure.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... purpose of conserving soil and water resources, protecting or restoring the environment, improving forests... payments. If a payment is made for several purposes, it may be considered as having soil and water conservation, environmental protection or restoration, forestry improvement, or providing wildlife habitat as...

  1. 7 CFR 14.5 - Procedure.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... purpose of conserving soil and water resources, protecting or restoring the environment, improving forests... payments. If a payment is made for several purposes, it may be considered as having soil and water conservation, environmental protection or restoration, forestry improvement, or providing wildlife habitat as...

  2. 47 CFR 1.2209 - Disbursement of incentive payments.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 47 Telecommunication 1 2014-10-01 2014-10-01 false Disbursement of incentive payments. 1.2209 Section 1.2209 Telecommunication FEDERAL COMMUNICATIONS COMMISSION GENERAL PRACTICE AND PROCEDURE Grants by Random Selection Competitive Bidding Proceedings Broadcast Television Spectrum Reverse Auction § 1...

  3. 7 CFR 14.5 - Procedure.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... purpose of conserving soil and water resources, protecting or restoring the environment, improving forests... payments. If a payment is made for several purposes, it may be considered as having soil and water conservation, environmental protection or restoration, forestry improvement, or providing wildlife habitat as...

  4. 7 CFR 14.5 - Procedure.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... purpose of conserving soil and water resources, protecting or restoring the environment, improving forests... payments. If a payment is made for several purposes, it may be considered as having soil and water conservation, environmental protection or restoration, forestry improvement, or providing wildlife habitat as...

  5. Coronary artery bypass grafts and diagnosis related groups: patient classification and hospital reimbursement in 10 European countries

    PubMed Central

    2014-01-01

    Background The prospective reimbursement of hospitals through the grouping of patients into a finite number of categories (Diagnosis Related Groups, DRGs), is common to many European countries. However, the specific categories used vary greatly across countries, using different characteristics to define group boundaries and thus those characteristics which result in different payments for treatment. In order to assist in the construction and modification of national DRG systems, this study analyses the DRG systems of 10 European countries. Aims To compare the characteristics used to categorise patients receiving a coronary artery bypass graft (CABG) surgery into DRGs. Further, to compare the structure into which DRGs are placed and the relative price paid for patients across Europe. Method Patients with a procedure of CABG surgery are analysed from Austria, England, Estonia, Finland, France, Germany, Ireland, Poland, Spain and Sweden. Diagrammatic algorithms of DRG structures are presented for each country. The price in Euros of seven typical case vignettes, each made up of a set of a hypothetical patient’s characteristics, is also analysed for each country. In order to enable comparisons across countries the simplest case (index vignette) is taken as baseline and relative price levels are calculated for the other six vignettes, each representing patients with different combinations of procedures and comorbidities. Results European DRG payment structures for CABG surgery vary in terms of the number of different DRGs used and the types of distinctions which define patient categorisation. Based on the payments given to hospitals in different countries, the most resource intensive patient, relative to the index vignette, ranges in magnitude from 1.37 in Poland to 2.82 in Ireland. There is also considerable variation in how much different systems pay for particular circumstances, such as the occurrence of catheterisation or presence of comorbidity. Conclusion Past experience of the construction of DRG systems for CABG patients demonstrates the variety of options available. It also highlights the importance of updating systems as frequently as possible, to incentivise best practice. PMID:24949279

  6. Design Challenges of an Episode-Based Payment Model in Oncology: The Centers for Medicare & Medicaid Services Oncology Care Model.

    PubMed

    Kline, Ronald M; Muldoon, L Daniel; Schumacher, Heidi K; Strawbridge, Larisa M; York, Andrew W; Mortimer, Laura K; Falb, Alison F; Cox, Katherine J; Bazell, Carol; Lukens, Ellen W; Kapp, Mary C; Rajkumar, Rahul; Bassano, Amy; Conway, Patrick H

    2017-07-01

    The Centers for Medicare & Medicaid Services developed the Oncology Care Model as an episode-based payment model to encourage participating practitioners to provide higher-quality, better-coordinated care at a lower cost to the nearly three-quarter million fee-for-service Medicare beneficiaries with cancer who receive chemotherapy each year. Episode payment models can be complex. They combine into a single benchmark price all payments for services during an episode of illness, many of which may be delivered at different times by different providers in different locations. Policy and technical decisions include the definition of the episode, including its initiation, duration, and included services; the identification of beneficiaries included in the model; and beneficiary attribution to practitioners with overall responsibility for managing their care. In addition, the calculation and risk adjustment of benchmark episode prices for the bundle of services must reflect geographic cost variations and diverse patient populations, including varying disease subtypes, medical comorbidities, changes in standards of care over time, the adoption of expensive new drugs (especially in oncology), as well as diverse practice patterns. Other steps include timely monitoring and intervention as needed to avoid shifting the attribution of beneficiaries on the basis of their expected episode expenditures as well as to ensure the provision of necessary medical services and the development of a meaningful link to quality measurement and improvement through the episode-based payment methodology. The complex and diverse nature of oncology business relationships and the specific rules and requirements of Medicare payment systems for different types of providers intensify these issues. The Centers for Medicare & Medicaid Services believes that by sharing its approach to addressing these decisions and challenges, it may facilitate greater understanding of the model within the oncology community and provide insight to others considering the development of episode-based payment models in the commercial or government sectors.

  7. Existing and Emerging Payment and Delivery Reforms in Cardiology

    PubMed Central

    Farmer, Steven A.; Darling, Margaret L.; George, Meaghan; Casale, Paul N.; Hagan, Eileen; McClellan, Mark B.

    2017-01-01

    IMPORTANCE Recent health care reforms aim to increase patient access, reduce costs, and improve health care quality as payers turn to payment reform for greater value. Cardiologists need to understand emerging payment models to succeed in the evolving payment landscape. We review existing payment and delivery reforms that affect cardiologists, present 4 emerging examples, and consider their implications for clinical practice. OBSERVATIONS Public and commercial payers have recently implemented payment reforms and new models are evolving. Most cardiology models are modified fee-for-service or address procedural or episodic care, but population models are also emerging. Although there is widespread agreement that payment reform is needed, existing programs have significant limitations and the adoption ofnew programs has been slow. New payment reforms address some of these problems, but many details remain undefined. CONCLUSIONS AND RELEVANCE Early payment reforms were voluntary and cardiologists’ participation is variable. However, conventional fee-for-service will become less viable, and enrollment in new payment models will be unavoidable. Early participation in new payment models will allow clinicians to develop expertise in new care pathways during a period of relatively lower risk. PMID:27851858

  8. Medicare program; FY 2014 inpatient prospective payment systems: changes to certain cost reporting procedures related to disproportionate share hospital uncompensated care payments. Interim final rule with comment period.

    PubMed

    2013-10-03

    : In the fiscal year (FY) 2014 inpatient prospective payment systems (IPPS)/long-term care hospital (LTCH) PPS final rule, we established the methodology for determining the amount of uncompensated care payments made to hospitals eligible for the disproportionate share hospital (DSH) payment adjustment in FY 2014 and a process for making interim and final payments. This interim final rule with comment period revises certain operational considerations for hospitals with Medicare cost reporting periods that span more than one Federal fiscal year and also makes changes to the data that will be used in the uncompensated care payment calculation in order to ensure that data from Indian Health Service (IHS) hospitals are included in Factor 1 and Factor 3 of that calculation.

  9. 78 FR 46905 - Tobacco Transition Program; Final Assessment Procedures

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-08-02

    ... adjusted market share for the 39th and 40th quarterly assessment payments due on September 30, 2014, will be based on the assessed entity's market activity during April 1 to June 30, 2014. The 40th quarterly assessment will be initially determined by using the same adjusted market share of an entity that was used to...

  10. 20 CFR Appendix C to Part 617 - Standard for Fraud and Overpayment Detection

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... cases to test the effectiveness of the agency's procedures for the prevention of payments which are not... records are comonly made either by post-audit or by industry surveys. The so-called “post-audit” is a... to be checked against concurrent benefit lists. A plan of investigation based on a sample post-audit...

  11. 20 CFR Appendix C to Part 617 - Standard for Fraud and Overpayment Detection

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... cases to test the effectiveness of the agency's procedures for the prevention of payments which are not... records are comonly made either by post-audit or by industry surveys. The so-called “post-audit” is a... to be checked against concurrent benefit lists. A plan of investigation based on a sample post-audit...

  12. 20 CFR Appendix C to Part 617 - Standard for Fraud and Overpayment Detection

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... cases to test the effectiveness of the agency's procedures for the prevention of payments which are not... records are comonly made either by post-audit or by industry surveys. The so-called “post-audit” is a... to be checked against concurrent benefit lists. A plan of investigation based on a sample post-audit...

  13. Malpractice claims for endoscopy

    PubMed Central

    Hernandez, Lyndon V; Klyve, Dominic; Regenbogen, Scott E

    2013-01-01

    AIM: To summarize the magnitude and time trends of endoscopy-related claims and to compare total malpractice indemnity according to specialty and procedure. METHODS: We obtained data from a comprehensive database of closed claims from a trade association of professional liability insurance carriers, representing over 60% of practicing United States physicians. Total payments by procedure and year were calculated, and were adjusted for inflation (using the Consumer Price Index) to 2008 dollars. Time series analysis was performed to assess changes in the total value of claims for each type of procedure over time. RESULTS: There were 1901 endoscopy-related closed claims against all providers from 1985 to 2008. The specialties include: internal medicine (n = 766), gastroenterology (n = 562), general surgery (n = 231), general and family practice (n = 101), colorectal surgery (n = 87), other specialties (n = 132), and unknown (n = 22). Colonoscopy represented the highest frequencies of closed claims (n = 788) and the highest total indemnities ($54 093 000). In terms of mean claims payment, endoscopic retrograde cholangiopancreatography (ERCP) ranked the highest ($374  794) per claim. Internists had the highest number of total claims (n = 766) and total claim payment ($70  730  101). Only total claim payments for colonoscopy and ERCP seem to have increased over time. Indeed, there was an average increase of 15.5% per year for colonoscopy and 21.9% per year for ERCP after adjusting for inflation. CONCLUSION: There appear to be differences in malpractice coverage costs among specialties and the type of endoscopic procedure. There is also evidence for secular trend in total claim payments, with colonoscopy and ERCP costs rising yearly even after adjusting for inflation. PMID:23596540

  14. Medicare Program; Comprehensive Care for Joint Replacement Payment Model for Acute Care Hospitals Furnishing Lower Extremity Joint Replacement Services. Final rule.

    PubMed

    2015-11-24

    This final rule implements a new Medicare Part A and B payment model under section 1115A of the Social Security Act, called the Comprehensive Care for Joint Replacement (CJR) model, in which acute care hospitals in certain selected geographic areas will receive retrospective bundled payments for episodes of care for lower extremity joint replacement (LEJR) or reattachment of a lower extremity. All related care within 90 days of hospital discharge from the joint replacement procedure will be included in the episode of care. We believe this model will further our goals in improving the efficiency and quality of care for Medicare beneficiaries with these common medical procedures.

  15. Bundled payment fails to gain a foothold In California: the experience of the IHA bundled payment demonstration.

    PubMed

    Ridgely, M Susan; de Vries, David; Bozic, Kevin J; Hussey, Peter S

    2014-08-01

    To determine whether bundled payment could be an effective payment model for California, the Integrated Healthcare Association convened a group of stakeholders (health plans, hospitals, ambulatory surgery centers, physician organizations, and vendors) to develop, through a consensus process, the methods and means of implementing bundled payment. In spite of a high level of enthusiasm and effort, the pilot did not succeed in its goal to implement bundled payment for orthopedic procedures across multiple payers and hospital-physician partners. An evaluation of the pilot documented a number of barriers, such as administrative burden, state regulatory uncertainty, and disagreements about bundle definition and assumption of risk. Ultimately, few contracts were signed, which resulted in insufficient volume to test hypotheses about the impact of bundled payment on quality and costs. Although bundled payment failed to gain a foothold in California, the evaluation provides lessons for future bundled payment initiatives. Project HOPE—The People-to-People Health Foundation, Inc.

  16. Private-sector vaccine purchase costs and insurer payments: a disincentive for using combination vaccines?

    PubMed

    Clark, Sarah J; Cowan, Anne E; Freed, Gary L

    2011-04-01

    Combination vaccines have been endorsed as a means to decrease the number of injections needed to complete the childhood immunization schedule, yet anecdotal reports suggest that private providers lose money on combination vaccines. The objective of this study was to determine whether practices purchasing combination vaccines had significantly different vaccine costs and reimbursement compared to practices that were not purchasing combination vaccines. Using cross-sectional purchase and insurer payment data collected from a targeted sample of private practices in five US states, we calculated the average total vaccine cost and reimbursement across the childhood immunization schedule. The average vaccine purchase cost across the childhood schedule was significantly higher for practices using a combined vaccine with diphtheria, tetanus, acellular pertussis vaccine, inactivated polio vaccine, and Hepatitis B vaccine (DTaP-IPV-HepB) than for practices using either separate vaccine products or a combined vaccine with Haemophilus influenzae, type b vaccine and Hepatitis B vaccine (Hib-HepB). The average insurer payment for vaccine administration across the childhood schedule was significantly lower for practices using DTaP-IPV-HepB combination vaccine than for practices using separate vaccine products. This study appears to validate anecdotal reports that vaccine purchase costs and insurer payment for combination vaccines can have a negative financial impact for practices that purchase childhood vaccines.

  17. Costs of disposable material in the operating room do not show high correlation with surgical time: Implications for hospital payment.

    PubMed

    Delo, Caroline; Leclercq, Pol; Martins, Dimitri; Pirson, Magali

    2015-08-01

    The objectives of this study are to analyze the variation of the surgical time and of disposable costs per surgical procedure and to analyze the association between disposable costs and the surgical time. The registration of data was done in an operating room of a 419 bed general hospital, over a period of three months (n = 1556 surgical procedures). Disposable material per procedure used was recorded through a barcode scanning method. The average cost (standard deviation) of disposable material is €183.66 (€183.44). The mean surgical time (standard deviation) is 96 min (63). Results have shown that the homogeneity of operating time and DM costs was quite good per surgical procedure. The correlation between the surgical time and DM costs is not high (r = 0.65). In a context of Diagnosis Related Group (DRG) based hospital payment, it is important that costs information systems are able to precisely calculate costs per case. Our results show that the correlation between surgical time and costs of disposable materials is not good. Therefore, empirical data or itemized lists should be used instead of surgical time as a cost driver for the allocation of costs of disposable materials to patients. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  18. 23 CFR 140.601 - Purpose.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 23 Highways 1 2010-04-01 2010-04-01 false Purpose. 140.601 Section 140.601 Highways FEDERAL HIGHWAY ADMINISTRATION, DEPARTMENT OF TRANSPORTATION PAYMENT PROCEDURES REIMBURSEMENT Reimbursement for..., pursuant to 23 U.S.C. 122 and the payment of interest on bonds of eligible Interstate projects. ...

  19. 23 CFR 140.601 - Purpose.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 23 Highways 1 2011-04-01 2011-04-01 false Purpose. 140.601 Section 140.601 Highways FEDERAL HIGHWAY ADMINISTRATION, DEPARTMENT OF TRANSPORTATION PAYMENT PROCEDURES REIMBURSEMENT Reimbursement for..., pursuant to 23 U.S.C. 122 and the payment of interest on bonds of eligible Interstate projects. ...

  20. 23 CFR 140.601 - Purpose.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 23 Highways 1 2014-04-01 2014-04-01 false Purpose. 140.601 Section 140.601 Highways FEDERAL HIGHWAY ADMINISTRATION, DEPARTMENT OF TRANSPORTATION PAYMENT PROCEDURES REIMBURSEMENT Reimbursement for..., pursuant to 23 U.S.C. 122 and the payment of interest on bonds of eligible Interstate projects. ...

  1. 23 CFR 140.601 - Purpose.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 23 Highways 1 2013-04-01 2013-04-01 false Purpose. 140.601 Section 140.601 Highways FEDERAL HIGHWAY ADMINISTRATION, DEPARTMENT OF TRANSPORTATION PAYMENT PROCEDURES REIMBURSEMENT Reimbursement for..., pursuant to 23 U.S.C. 122 and the payment of interest on bonds of eligible Interstate projects. ...

  2. 12 CFR 1208.42 - Administrative offset prior to completion of procedures.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... a recoupment (i.e., FHFA may offset a payment due to the debtor when both the payment due to the... administrative offsets, FHFA first learns of the existence of a debt due when there would be insufficient time to...

  3. 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.

  4. Cost minimisation analysis of using acellular dermal matrix (Strattice™) for breast reconstruction compared with standard techniques.

    PubMed

    Johnson, R K; Wright, C K; Gandhi, A; Charny, M C; Barr, L

    2013-03-01

    We performed a cost analysis (using UK 2011/12 NHS tariffs as a proxy for cost) comparing immediate breast reconstruction using the new one-stage technique of acellular dermal matrix (Strattice™) with implant versus the standard alternative techniques of tissue expander (TE)/implant as a two-stage procedure and latissimus dorsi (LD) flap reconstruction. Clinical report data were collected for operative time, length of stay, outpatient procedures, and number of elective and emergency admissions in our first consecutive 24 patients undergoing one-stage Strattice reconstruction. Total cost to the NHS based on tariff, assuming top-up payments to cover Strattice acquisition costs, was assessed and compared to the two historical control groups matched on key variables. Eleven patients having unilateral Strattice reconstruction were compared to 10 having TE/implant reconstruction and 10 having LD flap and implant reconstruction. Thirteen patients having bilateral Strattice reconstruction were compared to 12 having bilateral TE/implant reconstruction. Total costs were: unilateral Strattice, £3685; unilateral TE, £4985; unilateral LD and implant, £6321; bilateral TE, £5478; and bilateral Strattice, £6771. The cost analysis shows a financial advantage of using acellular dermal matrix (Strattice) in unilateral breast reconstruction versus alternative procedures. The reimbursement system in England (Payment by Results) is based on disease-related groups similar to that of many countries across Europe and tariffs are based on reported hospital costs, making this analysis of relevance in other countries. Copyright © 2013 Elsevier Ltd. All rights reserved.

  5. Risk adjustment policy options for casemix funding: international lessons in financing reform.

    PubMed

    Antioch, Kathryn M; Ellis, Randall P; Gillett, Steve; Borovnicar, Daniel; Marshall, Ric P

    2007-09-01

    This paper explores modified hospital casemix payment formulae that would refine the diagnosis-related group (DRG) system in Victoria, Australia, which already makes adjustments for teaching, severity and demographics. We estimate alternative casemix funding methods using multiple regressions for individual hospital episodes from 2001 to 2003 on 70 high-deficit DRGs, focussing on teaching hospitals where the largest deficits have occurred. Our casemix variables are diagnosis- and procedure-based severity markers, counts of diagnoses and procedures, disease types, complexity, day outliers, emergency admission and "transfers in." The results are presented for four policy options that vary according to whether all of the dollars or only some are reallocated, whether all or some hospitals are used and whether the alternatives augment or replace existing payments. While our approach identifies variables that help explain patient cost variations, hospital-level simulations suggest that the approaches explored would only reduce teaching hospital underpayment by about 10%. The implications of various policy options are discussed.

  6. 29 CFR 4.2 - Payment of minimum wage specified in section 6(a)(1) of the Fair Labor Standards Act of 1938...

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 29 Labor 1 2010-07-01 2010-07-01 true Payment of minimum wage specified in section 6(a)(1) of the... and Procedures § 4.2 Payment of minimum wage specified in section 6(a)(1) of the Fair Labor Standards... employees shall pay any employees engaged in such work less than the minimum wage specified in section 6(a...

  7. 40 CFR Appendix D to Part 307 - Notice of Limitations on the Payment of Claims for Response Actions Which Is To Be Placed in...

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 40 Protection of Environment 27 2010-07-01 2010-07-01 false Notice of Limitations on the Payment of Claims for Response Actions Which Is To Be Placed in Public Dockets D Appendix D to Part 307... (CERCLA) CLAIMS PROCEDURES Pt. 307, App. D Appendix D to Part 307—Notice of Limitations on the Payment of...

  8. 50 CFR 29.21-2 - Application procedures.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ...) State of local governments or agencies or instrumentalities thereof except as to rights-of-way... schedule: (A) For linear facilities (e.g., powerlines, pipelines, roads, etc.). Length Payment Less than 5... application includes both linear and nonlinear facilities, payment will be the aggregate of amounts under...

  9. 50 CFR 29.21-2 - Application procedures.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ...) State of local governments or agencies or instrumentalities thereof except as to rights-of-way... schedule: (A) For linear facilities (e.g., powerlines, pipelines, roads, etc.). Length Payment Less than 5... application includes both linear and nonlinear facilities, payment will be the aggregate of amounts under...

  10. 47 CFR 1.1158 - Form of payment for regulatory fees.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... instrument and cover mass media, common carrier, international, and cable service fee payments. Each... Section 1.1158 Telecommunication FEDERAL COMMUNICATIONS COMMISSION GENERAL PRACTICE AND PROCEDURE Schedule.... dollars and drawn on a United States financial institution and made payable to the Federal Communications...

  11. 24 CFR 888.415 - Restrictions on retroactive payments.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... HUD, will review whether rents were excessive when initially set. (c) Physical condition of projects. If the most recent physical inspection report by the PHA shows significant deficiencies that have not... to all regulations, procedures, or restrictions that apply to Housing Assistance Payments. (b) Review...

  12. 47 CFR 1.1182 - Schedule of fees for products and services provided by the Commission in connection with...

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... telephone bill. Remote Bidding Software $175.00 per package Payment to auction contractor by credit card or... contractor by credit card or check. (Public Notice will specify exact payment procedures.) [60 FR 38280, July...

  13. 5 CFR 1315.7 - Discounts.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 5 Administrative Personnel 3 2010-01-01 2010-01-01 false Discounts. 1315.7 Section 1315.7 Administrative Personnel OFFICE OF MANAGEMENT AND BUDGET OMB DIRECTIVES PROMPT PAYMENT § 1315.7 Discounts. Agencies shall follow these procedures in taking discounts and determining the payment due dates when...

  14. Beyond Ability to Pay: Procedural Justice and Offender Compliance With Restitution Orders.

    PubMed

    Gladfelter, Andrew S; Lantz, Brendan; Ruback, R Barry

    2018-03-01

    Restitution to victims is rarely paid in full. One reason for low rates of payments is that offenders lack financial resources. Beyond ability to pay, however, we argue that fair treatment has implications for offender behavior. This study, a survey of probationers who owed restitution, investigated the links between (a) ability to pay, (b) beliefs about restitution and the criminal justice system, and (c) restitution payment, both the amount paid and number of payments. Results indicate that perceived fair treatment by probation staff-those most directly involved with the collection of restitution payments-was significantly associated with greater payment, net of past payment behavior, intention to pay, and ability to pay. Because restitution has potentially rehabilitative aspects if offenders pay more of the court-ordered amount and if they make regular monthly payments, how fairly probation staff treat probationers has implications for both victims and for the criminal justice system.

  15. 48 CFR 432.1007 - Administration and payment of performance-based payments.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 48 Federal Acquisition Regulations System 4 2010-10-01 2010-10-01 false Administration and payment of performance-based payments. 432.1007 Section 432.1007 Federal Acquisition Regulations System....1007 Administration and payment of performance-based payments. The responsibility for receiving...

  16. 10 CFR 1023.329 - Payment of award.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... official. The agency will pay the amount awarded to the applicant within 60 days. ... 10 Energy 4 2010-01-01 2010-01-01 false Payment of award. 1023.329 Section 1023.329 Energy DEPARTMENT OF ENERGY (GENERAL PROVISIONS) CONTRACT APPEALS Procedures Relating to Awards Under the Equal...

  17. 23 CFR 190.7 - Processing of claims.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 23 Highways 1 2010-04-01 2010-04-01 false Processing of claims. 190.7 Section 190.7 Highways FEDERAL HIGHWAY ADMINISTRATION, DEPARTMENT OF TRANSPORTATION PAYMENT PROCEDURES INCENTIVE PAYMENTS FOR CONTROLLING OUTDOOR ADVERTISING ON THE INTERSTATE SYSTEM § 190.7 Processing of claims. Audited and approved PR...

  18. 23 CFR 190.7 - Processing of claims.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 23 Highways 1 2014-04-01 2014-04-01 false Processing of claims. 190.7 Section 190.7 Highways FEDERAL HIGHWAY ADMINISTRATION, DEPARTMENT OF TRANSPORTATION PAYMENT PROCEDURES INCENTIVE PAYMENTS FOR CONTROLLING OUTDOOR ADVERTISING ON THE INTERSTATE SYSTEM § 190.7 Processing of claims. Audited and approved PR...

  19. 23 CFR 190.7 - Processing of claims.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 23 Highways 1 2011-04-01 2011-04-01 false Processing of claims. 190.7 Section 190.7 Highways FEDERAL HIGHWAY ADMINISTRATION, DEPARTMENT OF TRANSPORTATION PAYMENT PROCEDURES INCENTIVE PAYMENTS FOR CONTROLLING OUTDOOR ADVERTISING ON THE INTERSTATE SYSTEM § 190.7 Processing of claims. Audited and approved PR...

  20. 23 CFR 190.7 - Processing of claims.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 23 Highways 1 2013-04-01 2013-04-01 false Processing of claims. 190.7 Section 190.7 Highways FEDERAL HIGHWAY ADMINISTRATION, DEPARTMENT OF TRANSPORTATION PAYMENT PROCEDURES INCENTIVE PAYMENTS FOR CONTROLLING OUTDOOR ADVERTISING ON THE INTERSTATE SYSTEM § 190.7 Processing of claims. Audited and approved PR...

  1. 41 CFR 102-118.475 - Does interest apply after certification of payment of claims?

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... Management Federal Property Management Regulations System (Continued) FEDERAL MANAGEMENT REGULATION TRANSPORTATION 118-TRANSPORTATION PAYMENT AND AUDIT Claims and Appeal Procedures General Agency Information for... 41 Public Contracts and Property Management 3 2010-07-01 2010-07-01 false Does interest apply...

  2. 20 CFR 416.601 - Introduction.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false Introduction. 416.601 Section 416.601 Employees' Benefits SOCIAL SECURITY ADMINISTRATION SUPPLEMENTAL SECURITY INCOME FOR THE AGED, BLIND, AND DISABLED Representative Payment § 416.601 Introduction. (a) Explanation of representative payment. This subpart explains the principles and procedures...

  3. 76 FR 5070 - Offset of Tax Refund Payments To Collect Delinquent State Unemployment Compensation Debts

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-01-28

    ... Payments To Collect Delinquent State Unemployment Compensation Debts AGENCY: Financial Management Service... (referred to as ``tax refund offset'') to collect delinquent State unemployment compensation debts. The Department of the Treasury (Treasury) will incorporate the procedures necessary to collect State unemployment...

  4. 5 CFR 1620.46 - Agency responsibilities.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... eligible employees and notify them of their options under these regulations and the time period within... making payments to the record keeper for all contributions and attributable breakage will obtain from... making the payments to the record keeper will determine the procedure to follow in order to collect...

  5. A pilot project using evidence-based clinical pathways and payment reform in China's rural hospitals shows early success.

    PubMed

    Cheng, Tsung-Mei

    2013-05-01

    Reforming China's public hospitals to curb widespread overtreatment and improve the quality and affordability of care has been the most challenging aspect of that nation's ambitious health reform, which began in 2009. This article describes a pilot project under way in several of China's provinces that combines payment reform with the implementation of evidence-based clinical pathways at a few hospitals serving rural areas. Results to date include reduced length-of-stay and prescription drug use and higher patient and provider satisfaction. These early results suggest that the pilot may be achieving its goals, which may have far-reaching and positive implications for China's ongoing reform.

  6. 76 FR 45811 - Animal Drug User Fee Rates and Payment Procedures for Fiscal Year 2012

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-08-01

    ... Lisa Kable, Center for Veterinary Medicine (HFV-10), Food and Drug Administration, 7529 Standish Pl... Medicine (CVM) at: [email protected] . SUPPLEMENTARY INFORMATION: I. Background Section 740 of the FD&C... from the base years in column 3. At the bottom right of the table the sum of the values in column 5 is...

  7. 48 CFR 1532.003 - Simplified acquisition procedures financing.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... procedures financing. 1532.003 Section 1532.003 Federal Acquisition Regulations System ENVIRONMENTAL PROTECTION AGENCY GENERAL CONTRACTING REQUIREMENTS CONTRACT FINANCING 1532.003 Simplified acquisition procedures financing. (a) Scope. This subpart provides for authorization of advance and interim payments on...

  8. 5 CFR 550.204 - Agency procedures.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... following information to the employee in writing: (1) A statement indicating how the advance in pay will be... ADMINISTRATION (GENERAL) Advances in Pay § 550.204 Agency procedures. (a) Each agency shall establish written procedures governing advance payments. These procedures shall include— (1) Criteria to be considered before...

  9. 43 CFR 30.142 - Will a judge authorize payment of a claim from the trust estate if the decedent's non-trust...

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 43 Public Lands: Interior 1 2010-10-01 2010-10-01 false Will a judge authorize payment of a claim from the trust estate if the decedent's non-trust estate was or is available? 30.142 Section 30.142 Public Lands: Interior Office of the Secretary of the Interior INDIAN PROBATE HEARINGS PROCEDURES Claims § 30.142 Will a judge authorize payment of a...

  10. Comparative analysis of the current payment system for hospital services in Serbia and projected payments under diagnostic related groups system in urology.

    PubMed

    Babić, Uroš; Soldatović, Ivan; Vuković, Dejana; Milićević, Milena Šantrić; Stjepanović, Mihailo; Kojić, Dejan; Argirović, Aleksandar; Vukotić, Vinka

    2015-03-01

    Global budget per calendar year is a traditional method of funding hospitals in Serbia. Diagnose related groups (DGR) is a method of hospital payment based on classification of patients into groups with clinically similar problems and similar utilization of hospital resources. The aim of this study was to compare current methods of hospital services payment with the projected costs by DRG payment method in urology. The data were obtained from the information system used in the Clinical Hospital Center "Dr. Dragiša Mišović"--Dedinje in Belgrade, Serbia. The implemented hospital information system was the main criterion for selection of healthcare institutions. The study included 994 randomly selected patients treated surgically and conservatively in 2012. Average costs under the current payment method were slightly higher than those projected by DRG, however, the variability was twice as high (54,111 ± 69,789 compared to 53,434 ± 32,509, p < 0.001) respectively. The univariate analysis showed that the highest correlation with the current payment method as well as with the projected one by DRG was observed in relation to the number of days of hospitalization (ρ = 0.842, p < 0.001, and ρ = 0.637, p < 0.001, respectively). Multivariate regression models confirmed the influence of the number of hospitalization days to costs under the current payment system (β = 0.843, p < 0.001) as well as under the projected DRG payment system (β = 0.737, p < 0.001). The same predictor was crucial for the difference in the current payment method and the pro- jected DRG payment methods (β = 0.501, p < 0.001). Payment under the DRG system is administratively more complex because it requires detailed and standardized coding of diagnoses and procedures, as well as the information on the average consumption of resources (costs) per DRG. Given that aggregate costs of treatment under two hospital payment methods compared in the study are not significantly different, the focus on minor surgeries both under the current hospital payment method and under the introduced DRG system would be far more cost-effective for a hospital as great variations in treatment performance (reductions of days of hospitalization and complications), and consequently invoiced amounts would be reduced.

  11. Professional efficiencies for diagnostic imaging services rendered by different physicians: analysis of recent medicare multiple procedure payment reduction policy.

    PubMed

    Duszak, Richard; Silva, Ezequiel; Kim, Angela J; Barr, Robert M; Donovan, William D; Kassing, Pamela; McGinty, Geraldine; Allen, Bibb

    2013-09-01

    The aim of this study was to quantify potential physician work efficiencies and appropriate multiple procedure payment reductions for different same-session diagnostic imaging studies interpreted by different physicians in the same group practice. Medicare Resource-Based Relative Value Scale data were analyzed to determine the relative contributions of various preservice, intraservice, and postservice physician diagnostic imaging work activities. An expert panel quantified potential duplications in professional work activities when separate examinations were performed during the same session by different physicians within the same group practice. Maximum potential work duplications for various imaging modalities were calculated and compared with those used as the basis of CMS payment policy. No potential intraservice work duplication was identified when different examination interpretations were rendered by different physicians in the same group practice. When multiple interpretations within the same modality were rendered by different physicians, maximum potential duplicated preservice and postservice activities ranged from 5% (radiography, fluoroscopy, and nuclear medicine) to 13.6% (CT). Maximum mean potential duplicated work relative value units ranged from 0.0049 (radiography and fluoroscopy) to 0.0413 (CT). This equates to overall potential total work reductions ranging from 1.39% (nuclear medicine) to 2.73% (CT). Across all modalities, this corresponds to maximum Medicare professional component physician fee reductions of 1.23 ± 0.38% (range, 0.95%-1.87%) for services within the same modality, much less than an order of magnitude smaller than those implemented by CMS. For services from different modalities, potential duplications were too small to quantify. Although potential efficiencies exist in physician preservice and postservice work when same-session, same-modality imaging services are rendered by different physicians in the same group practice, these are relatively minuscule and have been grossly overestimated by current CMS payment policy. Greater transparency and methodologic rigor in government payment policy development are warranted. Copyright © 2013 American College of Radiology. Published by Elsevier Inc. All rights reserved.

  12. Theory and Practice in the Design of Physician Payment Incentives

    PubMed Central

    Robinson, James C.

    2001-01-01

    Combining the economic literature on principal-agent relationships with examples of marketplace innovations allows analysis of the evolution of methods for paying physicians. Agency theory and the economic principles of performance-based compensation are applied in the context of imperfect information, risk aversion, multiple interrelated tasks, and team production efficiencies. Fee-for-service and capitation are flawed methods of motivating physicians to achieve specific goals. Payment innovations that blend elements of fee-for-service, capitation, and case rates can preserve the advantages and attenuate the disadvantages of each. These innovations include capitation with fee-for-service carve-outs, department budgets with individual fee-for-service or “contact” capitation, and case rates for defined episodes of illness. The context within which payment incentives are embedded, includes such nonprice mechanisms as screening and monitoring and such organizational relationships as employment and ownership. The analysis has implications for health services research and public policy with respect to physician payment incentives. PMID:11439463

  13. 48 CFR 32.1110 - Solicitation provision and contract clauses.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... database and maintain registration until final payment, unless— (i) Payment will be made through a third... the contractor to be registered in the CCR database. (ii)(A) If permitted by agency procedures, the... authorized, in accordance with 32.1106, to use a nondomestic EFT mechanism, the contracting officer shall...

  14. 47 CFR 1.1112 - Form of payment.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... Commission. Failure to comply with the Commission's procedures will result in the return of the application... not receive final payment and such failure is not excused by bank error. (2) The Commission will... attached to the receipt copy a stamped self-addressed envelope of sufficient size to contain the date...

  15. 5 CFR 2610.311 - Payment of award.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... THE EQUAL ACCESS TO JUSTICE ACT Procedures for Considering Applications § 2610.311 Payment of award..., Suite 500, 1201 New York Avenue NW., Washington, DC 20005-3917. The Office will pay the amount awarded to the applicant within 60 days, unless judicial review of the award or of the underlying decision of...

  16. 22 CFR 134.30 - Payment of award.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... will pay the amount awarded to the applicant within 60 days, unless judicial review of the award or of... 22 Foreign Relations 1 2010-04-01 2010-04-01 false Payment of award. 134.30 Section 134.30 Foreign Relations DEPARTMENT OF STATE MISCELLANEOUS EQUAL ACCESS TO JUSTICE ACT; IMPLEMENTATION Procedures for...

  17. 47 CFR 1.1157 - Payment of charges for regulatory fees.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... wireless radio, mass media, common carrier, cable and international services shall be filed in full on an... 47 Telecommunication 1 2010-10-01 2010-10-01 false Payment of charges for regulatory fees. 1.1157 Section 1.1157 Telecommunication FEDERAL COMMUNICATIONS COMMISSION GENERAL PRACTICE AND PROCEDURE Schedule...

  18. 7 CFR 226.10 - Program payment procedures.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... Agriculture Regulations of the Department of Agriculture (Continued) FOOD AND NUTRITION SERVICE, DEPARTMENT OF AGRICULTURE CHILD NUTRITION PROGRAMS CHILD AND ADULT CARE FOOD PROGRAM Payment Provisions § 226.10 Program... claimed and to enable the State agency to provide the final Report of the Child and Adult Care Food...

  19. 7 CFR 226.10 - Program payment procedures.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... Agriculture Regulations of the Department of Agriculture (Continued) FOOD AND NUTRITION SERVICE, DEPARTMENT OF AGRICULTURE CHILD NUTRITION PROGRAMS CHILD AND ADULT CARE FOOD PROGRAM Payment Provisions § 226.10 Program... claimed and to enable the State agency to provide the final Report of the Child and Adult Care Food...

  20. 7 CFR 226.10 - Program payment procedures.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... Agriculture Regulations of the Department of Agriculture (Continued) FOOD AND NUTRITION SERVICE, DEPARTMENT OF AGRICULTURE CHILD NUTRITION PROGRAMS CHILD AND ADULT CARE FOOD PROGRAM Payment Provisions § 226.10 Program... claimed and to enable the State agency to provide the final Report of the Child and Adult Care Food...

  1. 75 FR 4896 - Self-Regulatory Organizations; National Securities Clearing Corporation; Notice of Filing of...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-01-29

    ... To Eliminate Guarantee of Payment in Connection With the Envelope Settlement Service January 25, 2010...'s Rules & Procedures (``Rules'') to eliminate NSCC's guarantee of payment in connection with the... in Addendum D have been eliminated. The change to Addendum K deletes the provision that formerly...

  2. 48 CFR 532.905-70 - Final payment-construction and building service contracts.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 48 Federal Acquisition Regulations System 4 2012-10-01 2012-10-01 false Final payment-construction...-70 Final payment—construction and building service contracts. The following procedures apply to construction and building service contracts: (a) The Government shall pay the final amount due the Contractor...

  3. 48 CFR 532.905-70 - Final payment-construction and building service contracts.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 48 Federal Acquisition Regulations System 4 2014-10-01 2014-10-01 false Final payment-construction...-70 Final payment—construction and building service contracts. The following procedures apply to construction and building service contracts: (a) The Government shall pay the final amount due the Contractor...

  4. 48 CFR 532.905-70 - Final payment-construction and building service contracts.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 48 Federal Acquisition Regulations System 4 2013-10-01 2013-10-01 false Final payment-construction...-70 Final payment—construction and building service contracts. The following procedures apply to construction and building service contracts: (a) The Government shall pay the final amount due the Contractor...

  5. 20 CFR 220.145 - Impairment-related work expenses.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... work, the Board will deduct payments the claimant makes toward its cost. (5) Payments for drugs and medical services. (i) If the claimant must use drugs or medical services (including diagnostic procedures... drugs or services must be prescribed (or utilized) to reduce or eliminate symptoms of the claimant's...

  6. 75 FR 38533 - Medicare Program; Second Semi-Annual Meeting of the Advisory Panel on Ambulatory Payment...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-07-02

    ... participate fully in the Panel's work. Such expertise encompasses hospital payment systems; hospital medical care delivery systems; provider billing systems; APC groups; Current Procedural Terminology codes; and..., medical devices, and other services in the outpatient setting, as well as other forms of relevant...

  7. 22 CFR 221.21 - Event of Default; Application for Compensation; payment.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 22 Foreign Relations 1 2010-04-01 2010-04-01 false Event of Default; Application for Compensation; payment. 221.21 Section 221.21 Foreign Relations AGENCY FOR INTERNATIONAL DEVELOPMENT ISRAEL LOAN GUARANTEE STANDARD TERMS AND CONDITIONS Procedure for Obtaining Compensation § 221.21 Event of Default...

  8. 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.

  9. Do prices reflect the costs of cardiac surgery in the elderly?

    PubMed

    Coelho, Pedro; Rodrigues, Vanessa; Miranda, Luís; Fragata, José; Pita Barros, Pedro

    2017-01-01

    Payment for cardiac surgery in Portugal is based on a contract agreement between hospitals and the health ministry. Our aim was to compare the prices paid according to this contract agreement with calculated costs in a population of patients aged ≥65 years undergoing cardiac surgery in one hospital department. Data on 250 patients operated between September 2011 and September 2012 were prospectively collected. The procedures studied were coronary artery bypass graft surgery (CABG) (n=67), valve surgery (n=156) and combined CABG and valve surgery (n=27). Costs were calculated by two methods: micro-costing when feasible and mean length of stay otherwise. Price information was provided by the hospital administration and calculated using the hospital's mean case-mix. Thirty-day mortality was 3.2%. Mean EuroSCORE I was 5.97 (standard deviation [SD] 4.5%), significantly lower for CABG (p<0.01). Mean intensive care unit stay was 3.27 days (SD 4.7) and mean hospital stay was 9.92 days (SD 6.30), both significantly shorter for CABG. Calculated costs for CABG were €6539.17 (SD 3990.26), for valve surgery €8289.72 (SD 3319.93) and for combined CABG and valve surgery €11 498.24 (SD 10 470.57). The payment for each patient was €4732.38 in 2011 and €4678.66 in 2012 based on the case-mix index of the hospital group, which was 2.06 in 2011 and 2.21 in 2012; however, the case-mix in our sample was 6.48 in 2011 and 6.26 in 2012. The price paid for each patient was lower than the calculated costs. Prices would be higher than costs if the case-mix of the sample had been used. Costs were significantly lower for CABG. Copyright © 2016 Sociedade Portuguesa de Cardiologia. Publicado por Elsevier España, S.L.U. All rights reserved.

  10. 42 CFR 413.122 - Payment for hospital outpatient radiology services and other diagnostic procedures.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... and other diagnostic procedures. 413.122 Section 413.122 Public Health CENTERS FOR MEDICARE & MEDICAID... radiology services and other diagnostic procedures. (a) Basis and purpose. (1) This section implements... services and other diagnostic procedures performed by a hospital on an outpatient basis. (2) For purposes...

  11. 42 CFR 419.44 - Payment reductions for procedures.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... beneficiary copayment amounts if the procedure for which anesthesia is planned is discontinued after the induction of anesthesia or after the procedure is started; (2) One-half the full program and the beneficiary copayment amounts if the procedure for which anesthesia is planned is discontinued after the patient is...

  12. 42 CFR 419.44 - Payment reductions for procedures.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... beneficiary copayment amounts if the procedure for which anesthesia is planned is discontinued after the induction of anesthesia or after the procedure is started; (2) One-half the full program and the beneficiary copayment amounts if the procedure for which anesthesia is planned is discontinued after the patient is...

  13. 42 CFR 419.44 - Payment reductions for procedures.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... beneficiary copayment amounts if the procedure for which anesthesia is planned is discontinued after the induction of anesthesia or after the procedure is started; (2) One-half the full program and the beneficiary copayment amounts if the procedure for which anesthesia is planned is discontinued after the patient is...

  14. 48 CFR 32.1002 - Bases for performance-based payments.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 48 Federal Acquisition Regulations System 1 2011-10-01 2011-10-01 false Bases for performance... REGULATION GENERAL CONTRACTING REQUIREMENTS CONTRACT FINANCING Performance-Based Payments 32.1002 Bases for performance-based payments. Performance-based payments may be made on any of the following bases: (a...

  15. 48 CFR 32.1002 - Bases for performance-based payments.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 48 Federal Acquisition Regulations System 1 2012-10-01 2012-10-01 false Bases for performance... REGULATION GENERAL CONTRACTING REQUIREMENTS CONTRACT FINANCING Performance-Based Payments 32.1002 Bases for performance-based payments. Performance-based payments may be made on any of the following bases: (a...

  16. 48 CFR 32.1002 - Bases for performance-based payments.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 48 Federal Acquisition Regulations System 1 2013-10-01 2013-10-01 false Bases for performance... REGULATION GENERAL CONTRACTING REQUIREMENTS CONTRACT FINANCING Performance-Based Payments 32.1002 Bases for performance-based payments. Performance-based payments may be made on any of the following bases: (a...

  17. 48 CFR 32.1002 - Bases for performance-based payments.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 48 Federal Acquisition Regulations System 1 2010-10-01 2010-10-01 false Bases for performance... REGULATION GENERAL CONTRACTING REQUIREMENTS CONTRACT FINANCING Performance-Based Payments 32.1002 Bases for performance-based payments. Performance-based payments may be made on any of the following bases: (a...

  18. Electrophysiology and structural interventions in adults with congenital heart disease: Comparison of combined versus separate procedures.

    PubMed

    Lindsay, Ian; Nik-Ahd, Farnoosh; Aboulhosn, Jamil A; Moore, Jeremy P

    2018-05-18

    Electrophysiologic (EP) and structural interventions in adult congenital heart disease (ACHD) are typically completed during separate hospital encounters. With planning/coordination, these cases can be combined. We hypothesized that this integrated approach would yield patient and health system benefits. Consecutive ACHD patients undergoing combined interventions were matched to controls with identical but separate procedures. Primary endpoints of total hospital length of stay and cost were compared. Sixty-six combined cases and 120 controls were identified (45% male, mean age 36.2 ± 14.2 years). The most common diagnoses were Fontan (27%), tetralogy of Fallot (23%), and transposition complexes (20%). The most common EP procedure was catheter ablation (n = 30) followed by electrophysiologic study (n = 13); the most common structural intervention was transcatheter valve replacement (n = 16) followed by angioplasty/stenting (n = 14). Compared to controls, cases showed shorter anesthesia duration (323 [IQR 238-405] vs. 355 minutes [270-498], P = 0.06), smaller contrast dose (130 [50-189] vs. 177 mL [94-228], P = 0.045), fewer venipunctures (4 [3-4] vs. 6 [5-7], P < 0.001), and fewer work days missed (2 [2-5] vs. 4 [4-6], P < 0.001). There was shorter hospital stay (30 [19-35] vs. 38 hours [26-50], P = 0.023) and a 37% reduction in hospital charges ($117,894 vs. $187,648; P = 0.039) and 27% reduction in payments ($65,757 vs. $88,859; P = 0.016), persisting after adjustment for group differences. There were no significant differences in number of complications or efficacy. There appear to be advantages to combining ACHD interventional procedures that include reductions in hospital length of stay and cost, without detectable difference in procedural outcome. Published 2018. This article is a U.S. Government work and is in the public domain in the U.S.A.

  19. Value-based contracting innovated Medicare advantage healthcare delivery and improved survival.

    PubMed

    Mandal, Aloke K; Tagomori, Gene K; Felix, Randell V; Howell, Scott C

    2017-02-01

    In Medicare Advantage (MA) with its CMS Hierarchical Condition Categories (CMS-HCC) payment model, CMS reimburses private plans (Medicare Advantage Organizations [MAOs]) with prospective, monthly, health-based or risk-adjusted, capitated payments. The effect of this payment methodology on healthcare delivery remains debatable. How value-based contracting generates cost efficiencies and improves clinical outcomes in MA is studied. A difference in contracting arrangements between an MAO and 2 provider groups facilitated an intervention-control, preintervention-postintervention, difference-in-differences approach among statistically similar, elderly, community-dwelling MA enrollees within one metropolitan statistical area. Starting in 2009, for intervention-group MA enrollees, the MAO and a provider group agreed to full-risk capitation combined with a revenue gainshare. The gainshare was based on increases in the Risk Adjustment Factor (RAF), which modified the CMS-HCC payments. For the control group, the MAO continued to reimburse another provider group through fee-for-service. RAF, utilization, and survival were followed until December 31, 2012. The intervention group's mean RAF increased significantly (P <.001), estimating $2,519,544 per 1000 members of additional revenue. The intervention increased office-based visits (P <.001). Emergency department visits (P <.001) and inpatient hospital admissions (P = .002) decreased. This change in utilization saved $2,071,293 per 1000 enrollees. By intensifying office-based care for these MA enrollees with multiple comorbidities, a 6% survival benefit with a 32.8% lower hazard of death (P <.001) was achieved. Value-based contracting can drive utilization patterns and improve clinical outcomes among chronically ill, elderly MA members.

  20. Automated management of radioactive sources in Saudi Arabia

    NASA Astrophysics Data System (ADS)

    Al-Kheliewi, Abdullah S.; Jamil, M. F.; Basar, M. R.; Tuwaili, W. R.

    2014-09-01

    For usage of radioactive substances, any facility has to register and take license from relevant authority of the country in which such facility is operating. In the Kingdom of Saudi Arabia (KSA), the authority for managing radioactive sources and providing licenses to organizations for its usage is the National Center of Radiation Protection (NCRP). This paper describes the system that automates registration and licensing process of the National Center of Radiation Protection. To provide 24×7 accesses to all the customers of NCRP, system is developed as web-based application that provide facility to online register, request license, renew license, check request status, view historical data and reports etc. and other features are provided as Electronic Services that would be accessible to users via internet. The system also was designed to streamline and optimize internal operations of NCRP besides providing ease of access to its customers by implementing a defined workflow through which every registration and license request will be routed. In addition to manual payment option, the system would also be integrated with SADAD (online payment system) that will avoid lengthy and cumbersome procedures associated with manual payment mechanism. Using SADAD payment option license fee could be paid through internet/ATM machine or branch of any designated bank, Payment will be instantly notified to NCRP hence delay in funds transfer and verification of invoice could be avoided, SADAD integration is discussed later in the document.

  1. Funding Intensive Care - Approaches in Systems Using Diagnosis-Related Groups.

    PubMed

    Ettelt, Stefanie; Nolte, Ellen

    2012-01-01

    This article summarizes a review of approaches to funding intensive care in health systems that use activity-based payment mechanisms based on diagnosis-related groups (DRGs) to reimburse hospital care in Australia (Victoria), Denmark, France, Germany, Italy, Spain, Sweden and the United States (Medicare). The study aims to inform the current debate about options for funding intensive care services for adults, children and newborns in England. Mechanisms of funding intensive care services tend to fall into three broad categories: (1) those that fund intensive care through DRGs as part of one episode of hospital care only (US Medicare, Germany, selected regions in Sweden and Italy; (2) those that use DRGs in combination with co-payments (Victoria, France); and (3) those that exclude intensive care from DRG funding and use an alternative form of payment, for example global budgets (Spain) or per diems (South Australia). The review suggests that there is no obvious example of "best practice" or dominant approach used by a majority of systems. Each approach has advantages and disadvantages, particularly in relation to the financial risk involved in providing intensive care. While the risk of underfunding intensive care may be highest in systems that apply DRGs to the entire episode of hospital care, including intensive care, concerns about potential underfunding were voiced in all systems reviewed here. Arrangements for additional funding in the form of co-payments or surcharges may reduce the risk of underfunding. However, these approaches also face the difficulty of determining the appropriate level of (additional) payment and balancing the incentive effect arising from higher payment.

  2. The effects of medical group practice and physician payment methods on costs of care.

    PubMed Central

    Kralewski, J E; Rich, E C; Feldman, R; Dowd, B E; Bernhardt, T; Johnson, C; Gold, W

    2000-01-01

    OBJECTIVE: To assess the effects of payment methods on the costs of care in medical group practices. DATA SOURCES: Eighty-six clinics providing services for a Blue Cross managed care program during 1995. The clinics were analyzed to determine the relationship between payment methods and cost of care. Cost and patient data were obtained from Blue Cross records, and medical group practice clinic data were obtained by a survey of those organizations. STUDY DESIGN: The effects of clinic and physician payment methods on per member per year (PMPY) adjusted patient costs are evaluated using a two-stage regression model. Patient costs are adjusted for differences in payment schedules; patient age, gender, and ACG; clinic organizational variables are included as explanatory variables. DATA COLLECTION: Patient cost data were extracted from Blue Cross claims files, and patient and physician data from their enrollee and provider data banks. Medical group practice data were obtained by a mailed survey with telephone follow-up. PRINCIPAL FINDINGS: Capitation payment is correlated with lower patient care costs. When combined with fee-for-service with withhold provisions, this effect is smaller indicating that these two clinic payment methods are not interchangeable. Clinics with more physician compensation based on measures of resource use or based on some share of the net revenue of the clinic have lower patient care costs than those with more compensation related to productivity or based on salary. Salary compensation is strongly associated with higher costs. The use of physician profiles and clinical guidelines is associated with lower costs, but referral management systems have no such effect. The lower cost clinics are the smaller, multispecialty clinics. CONCLUSIONS: This study indicates that payment methods at both the medical group practice and physician levels influence the cost of care. However, the methods by which that influence is manifest is not clear. Although the organizational structure of clinics and their use of managed care programs appear to play a role, this influence is less than expected. PMID:10966087

  3. 76 FR 71468 - Defense Federal Acquisition Regulation Supplement: Accelerate Small Business Payments (DFARS Case...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-11-18

    ... all small business concerns. In combination with the change to the regulations, DoD immediately began... Federal Acquisition Regulation Supplement: Accelerate Small Business Payments (DFARS Case 2011-D008... Regulation Supplement to accelerate payments to all small business concerns. DATES: Effective Date: November...

  4. Knowledge and opinions regarding Medicare reimbursement for laparoscopic cholecystectomy.

    PubMed

    Madan, Atul K; Tichansky, David S; Barton, Ginny E; Taddeucci, Raymond J

    2007-11-01

    Medicare, via its fee schedule, determines amount of payment to physicians for services for its beneficiaries. Because many private insurance companies base their payment schedule on Medicare rates, it is important for physicians to know the rates of commonly performed procedures. In addition, it seems that public perception is that physicians receive substantial payments for procedures. This investigation explores patient, student, resident, and surgeon knowledge and opinion of Medicare reimbursements for laparoscopic cholecystectomy. Patients, students, residents, and surgeons filled out an IRB-exempted survey. The survey included a written description of a laparoscopic cholecystectomy. All participants were asked to give their thoughts of what Medicare currently reimburses for a laparoscopic cholecystectomy ($622) and what they thought Medicare should reimburse for a laparoscopic cholecystectomy for our geographic area. There were 105 participants (47 patients, 17 medical students, 33 surgical residents, and 8 attending surgeons) in the investigation. The reported mean reimbursements of what each group thought Medicare pays were patients, $9,396; students, $3,077; residents, $800; and surgeons, $711. The reported mean reimbursements of what each group thought Medicare should pay were patients, $8,067; students, $3,971; residents, $1,444; and surgeons, $1,600. The mean reimbursements were statistically different between all groups in both the amount Medicare currently pays and the amount Medicare should pay. Most of our participants overestimated what Medicare currently pays for laparoscopic cholecystectomy. Even the mean amount reported in the attending surgeon group was greater than the actual payment. All groups felt Medicare should pay more than the current rate; however, only patients thought Medicare should pay less than they currently pay (probably because of the incorrect perception of the current fee schedule).

  5. Patient casemix classification for medicare psychiatric prospective payment.

    PubMed

    Drozd, Edward M; Cromwell, Jerry; Gage, Barbara; Maier, Jan; Greenwald, Leslie M; Goldman, Howard H

    2006-04-01

    For a proposed Medicare prospective payment system for inpatient psychiatric facility treatment, the authors developed a casemix classification to capture differences in patients' real daily resource use. Primary data on patient characteristics and daily time spent in various activities were collected in a survey of 696 patients from 40 inpatient psychiatric facilities. Survey data were combined with Medicare claims data to estimate intensity-adjusted daily cost. Classification and Regression Trees (CART) analysis of average daily routine and ancillary costs yielded several hierarchical classification groupings. Regression analysis was used to control for facility and day-of-stay effects in order to compare hierarchical models with models based on the recently proposed payment system of the Centers for Medicare & Medicaid Services. CART analysis identified a small set of patient characteristics strongly associated with higher daily costs, including age, psychiatric diagnosis, deficits in daily living activities, and detox or ECT use. A parsimonious, 16-group, fully interactive model that used five major DSM-IV categories and stratified by age, illness severity, deficits in daily living activities, dangerousness, and use of ECT explained 40% (out of a possible 76%) of daily cost variation not attributable to idiosyncratic daily changes within patients. A noninteractive model based on diagnosis-related groups, age, and medical comorbidity had explanatory power of only 32%. A regression model with 16 casemix groups restricted to using "appropriate" payment variables (i.e., those with clinical face validity and low administrative burden that are easily validated and provide proper care incentives) produced more efficient and equitable payments than did a noninteractive system based on diagnosis-related groups.

  6. The costs and financing of perinatal care in the United States.

    PubMed Central

    Long, S H; Marquis, M S; Harrison, E R

    1994-01-01

    OBJECTIVES. The purpose of this study was to estimate the aggregate annual costs of maternal and infant health care and to describe the flow of funds that finance that care. METHODS. Estimates of costs and financing based on household and provider surveys, third-party claims data, and hospital discharge data were combined into a single, best estimate. RESULTS. The total cost of perinatal care in 1989 was $27.8 billion, or $6850 per mother-infant pair. Payments made directly by patients or third parties for this care totaled $25.4 billion, or about 7% of personal health care spending by the nonaged population. Payments were less than costs because they did not include a value for direct delivery care or for bad debt and charity care, which accounted for $2.4 billion. Private insurance accounted for about 63% of total payments, and Medicaid accounted for 17% of the total. CONCLUSIONS. National health reform would provide windfall receipts to hospitals, which would receive payment for the considerable bad debt and charity care they provide. Reform might also provide short-term gains to providers as private payment rates are substituted for those of Medicaid. PMID:8092374

  7. Early Lessons on Bundled Payment at an Academic Medical Center.

    PubMed

    Jubelt, Lindsay E; Goldfeld, Keith S; Blecker, Saul B; Chung, Wei-Yi; Bendo, John A; Bosco, Joseph A; Errico, Thomas J; Frempong-Boadu, Anthony K; Iorio, Richard; Slover, James D; Horwitz, Leora I

    2017-09-01

    Orthopaedic care is shifting to alternative payment models. We examined whether New York University Langone Medical Center achieved savings under the Centers for Medicare and Medicaid Services Bundled Payments for Care Improvement initiative. This study was a difference-in-differences study of Medicare fee-for-service patients hospitalized from April 2011 to June 2012 and October 2013 to December 2014 for lower extremity joint arthroplasty, cardiac valve procedures, or spine surgery (intervention groups), or for congestive heart failure, major bowel procedures, medical peripheral vascular disorders, medical noninfectious orthopaedic care, or stroke (control group). We examined total episode costs and costs by service category. We included 2,940 intervention episodes and 1,474 control episodes. Relative to the trend in the control group, lower extremity joint arthroplasty episodes achieved the greatest savings: adjusted average episode cost during the intervention period decreased by $3,017 (95% confidence interval [CI], -$6,066 to $31). For cardiac procedures, the adjusted average episode cost decreased by $2,999 (95% CI, -$8,103 to $2,105), and for spinal fusion, it increased by $8,291 (95% CI, $2,879 to $13,703). Savings were driven predominantly by shifting postdischarge care from inpatient rehabilitation facilities to home. Spinal fusion index admission costs increased because of changes in surgical technique. Under bundled payment, New York University Langone Medical Center decreased total episode costs in patients undergoing lower extremity joint arthroplasty. For patients undergoing cardiac valve procedures, evidence of savings was not as strong, and for patients undergoing spinal fusion, total episode costs increased. For all three conditions, the proportion of patients referred to inpatient rehabilitation facilities upon discharge decreased. These changes were not associated with an increase in index hospital length of stay or readmission rate. Opportunities for savings under bundled payment may be greater for lower extremity joint arthroplasty than for other conditions.

  8. Audit of Clinical Coding of Major Head and Neck Operations

    PubMed Central

    Mitra, Indu; Malik, Tass; Homer, Jarrod J; Loughran, Sean

    2009-01-01

    INTRODUCTION Within the NHS, operations are coded using the Office of Population Censuses and Surveys (OPCS) classification system. These codes, together with diagnostic codes, are used to generate Healthcare Resource Group (HRG) codes, which correlate to a payment bracket. The aim of this study was to determine whether allocated procedure codes for major head and neck operations were correct and reflective of the work undertaken. HRG codes generated were assessed to determine accuracy of remuneration. PATIENTS AND METHODS The coding of consecutive major head and neck operations undertaken in a tertiary referral centre over a retrospective 3-month period were assessed. Procedure codes were initially ascribed by professional hospital coders. Operations were then recoded by the surgical trainee in liaison with the head of clinical coding. The initial and revised procedure codes were compared and used to generate HRG codes, to determine whether the payment banding had altered. RESULTS A total of 34 cases were reviewed. The number of procedure codes generated initially by the clinical coders was 99, whereas the revised codes generated 146. Of the original codes, 47 of 99 (47.4%) were incorrect. In 19 of the 34 cases reviewed (55.9%), the HRG code remained unchanged, thus resulting in the correct payment. Six cases were never coded, equating to £15,300 loss of payment. CONCLUSIONS These results highlight the inadequacy of this system to reward hospitals for the work carried out within the NHS in a fair and consistent manner. The current coding system was found to be complicated, ambiguous and inaccurate, resulting in loss of remuneration. PMID:19220944

  9. 26 CFR 301.6311-2 - Payment by credit card and debit card.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... business and is not returned pursuant to paragraph (d)(3) of this section. (c) Payment not made—(1... required to be returned pursuant to paragraph (d)(3) of this section. This continuing liability of the.... (3) Return of funds pursuant to error resolution procedures. Notwithstanding section 6402, if a...

  10. 42 CFR 488.442 - Civil money penalties: Due date for payment of penalty.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 5 2014-10-01 2014-10-01 false Civil money penalties: Due date for payment of penalty. 488.442 Section 488.442 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF... PROCEDURES Enforcement of Compliance for Long-Term Care Facilities with Deficiencies § 488.442 Civil money...

  11. 42 CFR 488.442 - Civil money penalties: Due date for payment of penalty.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 42 Public Health 5 2012-10-01 2012-10-01 false Civil money penalties: Due date for payment of penalty. 488.442 Section 488.442 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF... PROCEDURES Enforcement of Compliance for Long-Term Care Facilities with Deficiencies § 488.442 Civil money...

  12. 42 CFR 488.442 - Civil money penalties: Due date for payment of penalty.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 5 2010-10-01 2010-10-01 false Civil money penalties: Due date for payment of penalty. 488.442 Section 488.442 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF... PROCEDURES Enforcement of Compliance for Long-Term Care Facilities with Deficiencies § 488.442 Civil money...

  13. 42 CFR 488.442 - Civil money penalties: Due date for payment of penalty.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 5 2011-10-01 2011-10-01 false Civil money penalties: Due date for payment of penalty. 488.442 Section 488.442 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF... PROCEDURES Enforcement of Compliance for Long-Term Care Facilities with Deficiencies § 488.442 Civil money...

  14. 42 CFR 488.442 - Civil money penalties: Due date for payment of penalty.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 42 Public Health 5 2013-10-01 2013-10-01 false Civil money penalties: Due date for payment of penalty. 488.442 Section 488.442 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF... PROCEDURES Enforcement of Compliance for Long-Term Care Facilities with Deficiencies § 488.442 Civil money...

  15. Paying for Children's Medical Care: Is the Medicare Experience Helpful?

    ERIC Educational Resources Information Center

    Moon, Marilyn; And Others

    1993-01-01

    Discusses the implications of the Medicare program's rate setting system on health care reform and considers whether such a procedure could be applied to a health insurance system that included children. Examines desirable characteristics of a provider payment system, special health needs of children, and hospital and physician payment issues.…

  16. 76 FR 78827 - Loan Guaranty Revised Loan Modification Procedures

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-12-20

    ... benefits the veteran by eliminating the delinquency and granting a ``fresh start'' on payment of the loan... delinquency, could raise serious questions about the veteran's ability to repay the modified loan. That would... accrued delinquency, then there is no need to require that payments on a modified loan be lower than the...

  17. 7 CFR 1785.70 - Application of RETRF cushion of credit payments.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 7 Agriculture 12 2010-01-01 2010-01-01 false Application of RETRF cushion of credit payments. 1785.70 Section 1785.70 Agriculture Regulations of the Department of Agriculture (Continued) RURAL UTILITIES SERVICE, DEPARTMENT OF AGRICULTURE (CONTINUED) LOAN ACCOUNT COMPUTATIONS, PROCEDURES AND POLICIES FOR ELECTRIC AND TELEPHONE BORROWERS RUS...

  18. 7 CFR 1785.70 - Application of RETRF cushion of credit payments.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 7 Agriculture 12 2012-01-01 2012-01-01 false Application of RETRF cushion of credit payments. 1785.70 Section 1785.70 Agriculture Regulations of the Department of Agriculture (Continued) RURAL UTILITIES SERVICE, DEPARTMENT OF AGRICULTURE (CONTINUED) LOAN ACCOUNT COMPUTATIONS, PROCEDURES AND POLICIES FOR ELECTRIC AND TELEPHONE BORROWERS RUS...

  19. 7 CFR 1785.70 - Application of RETRF cushion of credit payments.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 7 Agriculture 12 2011-01-01 2011-01-01 false Application of RETRF cushion of credit payments. 1785.70 Section 1785.70 Agriculture Regulations of the Department of Agriculture (Continued) RURAL UTILITIES SERVICE, DEPARTMENT OF AGRICULTURE (CONTINUED) LOAN ACCOUNT COMPUTATIONS, PROCEDURES AND POLICIES FOR ELECTRIC AND TELEPHONE BORROWERS RUS...

  20. 7 CFR 1785.70 - Application of RETRF cushion of credit payments.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 7 Agriculture 12 2013-01-01 2013-01-01 false Application of RETRF cushion of credit payments. 1785.70 Section 1785.70 Agriculture Regulations of the Department of Agriculture (Continued) RURAL UTILITIES SERVICE, DEPARTMENT OF AGRICULTURE (CONTINUED) LOAN ACCOUNT COMPUTATIONS, PROCEDURES AND POLICIES FOR ELECTRIC AND TELEPHONE BORROWERS RUS...

  1. 7 CFR 1785.70 - Application of RETRF cushion of credit payments.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 7 Agriculture 12 2014-01-01 2013-01-01 true Application of RETRF cushion of credit payments. 1785.70 Section 1785.70 Agriculture Regulations of the Department of Agriculture (Continued) RURAL UTILITIES SERVICE, DEPARTMENT OF AGRICULTURE (CONTINUED) LOAN ACCOUNT COMPUTATIONS, PROCEDURES AND POLICIES FOR ELECTRIC AND TELEPHONE BORROWERS RUS Cushio...

  2. 22 CFR 221.21 - Event of Default; Application for Compensation; payment.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 22 Foreign Relations 1 2013-04-01 2013-04-01 false Event of Default; Application for Compensation... GUARANTEE STANDARD TERMS AND CONDITIONS Procedure for Obtaining Compensation § 221.21 Event of Default; Application for Compensation; payment. At any time after an Event of Default, as this term is defined in an...

  3. 22 CFR 204.21 - Event of default; Application for compensation; Payment.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 22 Foreign Relations 1 2010-04-01 2010-04-01 false Event of default; Application for compensation... STANDARD TERMS AND CONDITIONS Procedure for Obtaining Compensation § 204.21 Event of default; Application for compensation; Payment. (a) Within one year after an Event of Default, as this term is defined in...

  4. 22 CFR 221.21 - Event of Default; Application for Compensation; payment.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 22 Foreign Relations 1 2012-04-01 2012-04-01 false Event of Default; Application for Compensation... GUARANTEE STANDARD TERMS AND CONDITIONS Procedure for Obtaining Compensation § 221.21 Event of Default; Application for Compensation; payment. At any time after an Event of Default, as this term is defined in an...

  5. 22 CFR 204.21 - Event of default; Application for compensation; Payment.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 22 Foreign Relations 1 2013-04-01 2013-04-01 false Event of default; Application for compensation... STANDARD TERMS AND CONDITIONS Procedure for Obtaining Compensation § 204.21 Event of default; Application for compensation; Payment. (a) Within one year after an Event of Default, as this term is defined in...

  6. 22 CFR 204.21 - Event of default; Application for compensation; Payment.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 22 Foreign Relations 1 2011-04-01 2011-04-01 false Event of default; Application for compensation... STANDARD TERMS AND CONDITIONS Procedure for Obtaining Compensation § 204.21 Event of default; Application for compensation; Payment. (a) Within one year after an Event of Default, as this term is defined in...

  7. 22 CFR 221.21 - Event of Default; Application for Compensation; payment.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 22 Foreign Relations 1 2011-04-01 2011-04-01 false Event of Default; Application for Compensation... GUARANTEE STANDARD TERMS AND CONDITIONS Procedure for Obtaining Compensation § 221.21 Event of Default; Application for Compensation; payment. At any time after an Event of Default, as this term is defined in an...

  8. 22 CFR 204.21 - Event of default; Application for compensation; Payment.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 22 Foreign Relations 1 2012-04-01 2012-04-01 false Event of default; Application for compensation... STANDARD TERMS AND CONDITIONS Procedure for Obtaining Compensation § 204.21 Event of default; Application for compensation; Payment. (a) Within one year after an Event of Default, as this term is defined in...

  9. 22 CFR 204.21 - Event of default; Application for compensation; Payment.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 22 Foreign Relations 1 2014-04-01 2014-04-01 false Event of default; Application for compensation... STANDARD TERMS AND CONDITIONS Procedure for Obtaining Compensation § 204.21 Event of default; Application for compensation; Payment. (a) Within one year after an Event of Default, as this term is defined in...

  10. 22 CFR 221.21 - Event of Default; Application for Compensation; payment.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 22 Foreign Relations 1 2014-04-01 2014-04-01 false Event of Default; Application for Compensation... GUARANTEE STANDARD TERMS AND CONDITIONS Procedure for Obtaining Compensation § 221.21 Event of Default; Application for Compensation; payment. At any time after an Event of Default, as this term is defined in an...

  11. Do Changes in Hospital Outpatient Payments Affect the Setting of Care?

    PubMed Central

    He, Daifeng; Mellor, Jennifer M

    2013-01-01

    Objective To examine whether decreases in Medicare outpatient payment rates under the Outpatient Prospective Payment System (OPPS) caused outpatient care to shift toward the inpatient setting. Data Sources/Study Setting Hospital inpatient and outpatient discharge files from the Florida Agency for Health Care Administration from 1997 through 2008. Study Design This study focuses on inguinal hernia repair surgery, one of the most commonly performed surgical procedures in the United States. We estimate multivariate regressions of inguinal hernia surgery counts in the outpatient setting and in the inpatient setting. The key explanatory variable is the time-varying Medicare payment rate specific to the procedure and hospital. Control variables include time-varying hospital and county characteristics and hospital and year-fixed effects. Principal Findings Outpatient hernia surgeries fell in response to OPPS-induced rate cuts. The volume of inpatient hernia repair surgeries did not increase in response to reductions in the outpatient reimbursement rate. Conclusions Potential substitution from the outpatient setting to the inpatient setting does not pose a serious threat to Medicare's efforts to contain hospital outpatient costs. PMID:23701048

  12. Comparing The Effects Of Reference Pricing And Centers-Of-Excellence Approaches To Value-Based Benefit Design.

    PubMed

    Zhang, Hui; Cowling, David W; Facer, Matthew

    2017-12-01

    Various health insurance benefit designs based on value-based purchasing have been promoted to steer patients to high-value providers, but little is known about the designs' relative effectiveness and underlying mechanisms. We compared the impact of two designs implemented by the California Public Employees' Retirement System on inpatient hospital total hip or knee replacement: a reference-based pricing design for preferred provider organizations (PPOs) and a centers-of-excellence design for health maintenance organizations (HMOs). Payment and utilization data for the procedures in the period 2008-13 were evaluated using pre-post and quasi-experimental designs at the system and health plan levels, adjusting for demographic characteristics, case-mix, and other confounders. We found that both designs prompted higher use of designated low-price high-quality facilities and reduced average replacement expenses per member at the plan and system levels. However, the designs used different routes: The reference-based pricing design reduced average replacement payments per case in PPOs by 26.7 percent in the first year, compared to HMOs, but did not lower PPO members' utilization rates. In contrast, the centers-of-excellence design lowered HMO members' utilization rates by 29.2 percent in the first year, compared to PPOs, but did not reduce HMO average replacement payments per case. The reference-based pricing design appears more suitable for reducing price variation, and the centers-of-excellence design for addressing variation in use.

  13. 42 CFR 419.44 - Payment reductions for procedures.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... amounts if the procedure for which anesthesia is planned is discontinued after the induction of anesthesia... amounts if the procedure for which anesthesia is planned is discontinued after the patient is prepared and taken to the room where the procedure is to be performed but before anesthesia is induced; or (3) One...

  14. 42 CFR 419.44 - Payment reductions for procedures.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... amounts if the procedure for which anesthesia is planned is discontinued after the induction of anesthesia... amounts if the procedure for which anesthesia is planned is discontinued after the patient is prepared and taken to the room where the procedure is to be performed but before anesthesia is induced; or (3) One...

  15. Application of the resource-based relative value scale system to pediatrics.

    PubMed

    Gerstle, Robert S; Molteni, Richard A; Andreae, Margie C; Bradley, Joel F; Brewer, Eileen D; Calabrese, Jamie; Krug, Steven E; Liechty, Edward A; Linzer, Jeffrey F; Pillsbury, Julia M; Tuli, Sanjeev Y

    2014-06-01

    The majority of public and private payers in the United States currently use the Medicare Resource-Based Relative Value Scale as the basis for physician payment. Many large group and academic practices have adopted this objective system of physician work to benchmark physician productivity, including using it, wholly or in part, to determine compensation. The Resource-Based Relative Value Scale survey instrument, used to value physician services, was designed primarily for procedural services, leading to current concerns that American Medical Association/Specialty Society Relative Value Scale Update Committee (RUC) surveys may undervalue nonprocedural evaluation and management services. The American Academy of Pediatrics is represented on the RUC, the committee charged with maintaining accurate physician work values across specialties and age groups. The Academy, working closely with other primary care and subspecialty societies, actively pursues a balanced RUC membership and a survey instrument that will ensure appropriate work relative value unit assignments, thereby allowing pediatricians to receive appropriate payment for their services relative to other services.

  16. Identifying Radiology's Place in the Expanding Landscape of Episode Payment Models.

    PubMed

    Rosenkrantz, Andrew B; Hirsch, Joshua A; Allen, Bibb; Harvey, H Benjamin; Nicola, Gregory N

    2017-07-01

    The current fee-for-service system for health care reimbursement in the United Stated is argued to encourage fragmented care delivery and a lack of accountability that predisposes to insufficient focus on quality as well as unnecessary or duplicative resource utilization. Episode payment models (EPMs) seek to improve coordination by linking payments for all services related to a patient's condition or procedure, thereby improving quality and efficiency of care. The CMS Innovation Center has implemented a broadening array of EPMs. Early models with relevance to radiologists include Bundled Payment for Care Improvement (involving 48 possible clinical conditions), Comprehensive Care for Joint Replacement (involving knee and hip replacement), and the Oncology Care Model (involving chemotherapy). In July 2016, CMS expanded the range of EPMs through three new models with mandatory hospital participation addressing inpatient and 90-day postdischarge care for acute myocardial infarction, coronary artery bypass graft, and surgical hip and femur fracture treatment. Moreover, some of the EPMs include tracks that allow participating entities to qualify as an Advanced Alternative Payment Model under the Medicare Access and CHIP Reauthorization Act (MACRA), reaping the associated reporting and payment benefits. Even though none of the available EPMs are radiology specific, the models will nevertheless likely influence reimbursements for some radiologists. Thus, radiologists should partner with hospitals and other specialties in care coordination through these episode-based initiatives, thereby having opportunities to apply their imaging expertise to help lower spending while improving quality and overall levels of health. Copyright © 2017 American College of Radiology. Published by Elsevier Inc. All rights reserved.

  17. Physician Quality Reporting System (PQRS) for Interventional Pain Management Practices: Challenges and Opportunities.

    PubMed

    Manchikanti, Laxmaiah; Hammer, Marvel; Benyamin, Ramsin M; Hirsch, Joshua A

    2016-01-01

    Basing their rationale on multiple publications from Institute of Medicine (IOM), specifically Crossing the Quality Chasm, policy makers have focused on a broad range of issues, including assessment of the influence of medical practice organization structures on quality performance and development of quality measures. The 2006 Tax Relief and Health Care Act established the Physician Quality Reporting System (PQRS), to enable eligible professionals to report health care quality and health outcome information that cannot be obtained from standard Medicare claims. However, the Patient Protection and Affordable Care Act (ACA) of 2010 required the Centers for Medicare and Medicaid Services (CMS) to incorporate a combination of cost and quality into the payment systems for health care as a precursor to value-based payments. The final change to PQRS pending initiation after 2018, is based on the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) which has incorporated alternative payment models and merit-based payment systems. Recent publication of quality performance scores by CMS has been less than optimal. When voluntary participation began in July 2007, providers were paid a bonus for reporting quality measures from 2008 through 2014, ranging from 0.5% to 2% of the Medicare Part B allowed charges furnished during the reporting period. Starting in 2015, penalties started for nonparticipation. Eligible professionals and group practices that failed to satisfactorily report data on quality measures during 2014 are subject to a 2% reduction in Medicare fee-for-service amounts for services furnished by the eligible professional or group practice during 2016. The CMS proposed rule for 2016 physician payments contained a number of provisions with proposed updates to the PQRS and Physician Value-Based Payment Modifier among other changes. The proposed rule is the first release since MACRA repealed the sustainable growth rate formula. CMS proposed to continue many existing policies regarding PQRS from 2015 to 2016. In addition, 2016 will be the year that is utilized to determine the 2018 PQRS payment adjustment. However, after 2018 the PQRS payment adjustment will be transitioned to the Merit-Based Incentive Payment System (MIPS), as required by MACRA. Overall, there will be over 280 measures in the 2016 PQRS.Readers might be surprised to find out that despite the cost intensity including time requirements personnel, the negative payment adjustments, are only the tip of the iceberg of cost. Indeed, all of the above may only be one-third or one-fourth of the cost to completely implement the PQRS system. Thus far, data across all specialties shows participation to be around 50%. In addition, penalties for lack of reporting of PQRS measures stands to be controversial to the Supreme Court ruling that unfunded mandates must not be permitted and also lack of significant relationships with improvement in quality in the overall analysis in multiple publications.

  18. The effect of state medicaid case-mix payment on nursing home resident acuity.

    PubMed

    Feng, Zhanlian; Grabowski, David C; Intrator, Orna; Mor, Vincent

    2006-08-01

    To examine the relationship between Medicaid case-mix payment and nursing home resident acuity. Longitudinal Minimum Data Set (MDS) resident assessments from 1999 to 2002 and Online Survey Certification and Reporting (OSCAR) data from 1996 to 2002, for all freestanding nursing homes in the 48 contiguous U.S. states. We used a facility fixed-effects model to examine the effect of introducing state case-mix payment on changes in nursing home case-mix acuity. Facility acuity was measured by aggregating the nursing case-mix index (NCMI) from the MDS using the Resource Utilization Group (Version III) resident classification system, separately for new admits and long-stay residents, and by an OSCAR-derived index combining a range of activity of daily living dependencies and special treatment measures. We followed facilities over the study period to create a longitudinal data file based on the MDS and OSCAR, respectively, and linked facilities with longitudinal data on state case-mix payment policies for the same period. Across three acuity measures and two data sources, we found that states shifting to case-mix payment increased nursing home acuity levels over the study period. Specifically, we observed a 2.5 percent increase in the average acuity of new admits and a 1.3 to 1.4 percent increase in the acuity of long-stay residents, following the introduction of case-mix payment. The adoption of case-mix payment increased access to care for higher acuity Medicaid residents.

  19. 42 CFR 431.972 - Claims sampling procedures.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 4 2010-10-01 2010-10-01 false Claims sampling procedures. 431.972 Section 431.972 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES... Estimating Improper Payments in Medicaid and CHIP § 431.972 Claims sampling procedures. (a) Claims universe...

  20. 42 CFR 431.972 - Claims sampling procedures.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 4 2011-10-01 2011-10-01 false Claims sampling procedures. 431.972 Section 431.972 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES... Estimating Improper Payments in Medicaid and CHIP § 431.972 Claims sampling procedures. (a) Claims universe...

  1. 22 CFR 1007.8 - Procedures for salary offset.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 22 Foreign Relations 2 2010-04-01 2010-04-01 true Procedures for salary offset. 1007.8 Section 1007.8 Foreign Relations INTER-AMERICAN FOUNDATION SALARY OFFSET § 1007.8 Procedures for salary offset... final salary or leave payments in accordance with 31 U.S.C. 3716. ...

  2. 42 CFR 416.172 - Adjustments to national payment rates.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... program and beneficiary coinsurance amounts if the procedure for which anesthesia is planned is discontinued after the induction of anesthesia or after the procedure is started; (2) One-half of the full program and beneficiary coinsurance amounts if the procedure for which anesthesia is planned is...

  3. 48 CFR 232.7003 - Procedures.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... Section 232.7003 Federal Acquisition Regulations System DEFENSE ACQUISITION REGULATIONS SYSTEM, DEPARTMENT OF DEFENSE GENERAL CONTRACTING REQUIREMENTS CONTRACT FINANCING Electronic Submission and Processing of Payment Requests and Receiving Reports 232.7003 Procedures. (a) The accepted electronic form for...

  4. 48 CFR 232.7003 - Procedures.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... Section 232.7003 Federal Acquisition Regulations System DEFENSE ACQUISITION REGULATIONS SYSTEM, DEPARTMENT OF DEFENSE GENERAL CONTRACTING REQUIREMENTS CONTRACT FINANCING Electronic Submission and Processing of Payment Requests and Receiving Reports 232.7003 Procedures. (a) The accepted electronic form for...

  5. 48 CFR 232.7003 - Procedures.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... Section 232.7003 Federal Acquisition Regulations System DEFENSE ACQUISITION REGULATIONS SYSTEM, DEPARTMENT OF DEFENSE GENERAL CONTRACTING REQUIREMENTS CONTRACT FINANCING Electronic Submission and Processing of Payment Requests and Receiving Reports 232.7003 Procedures. (a) The accepted electronic form for...

  6. 48 CFR 232.7003 - Procedures.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... Section 232.7003 Federal Acquisition Regulations System DEFENSE ACQUISITION REGULATIONS SYSTEM, DEPARTMENT OF DEFENSE GENERAL CONTRACTING REQUIREMENTS CONTRACT FINANCING Electronic Submission and Processing of Payment Requests and Receiving Reports 232.7003 Procedures. (a) The accepted electronic form for...

  7. 48 CFR 232.7003 - Procedures.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... Section 232.7003 Federal Acquisition Regulations System DEFENSE ACQUISITION REGULATIONS SYSTEM, DEPARTMENT OF DEFENSE GENERAL CONTRACTING REQUIREMENTS CONTRACT FINANCING Electronic Submission and Processing of Payment Requests and Receiving Reports 232.7003 Procedures. (a) The accepted electronic form for...

  8. Medicare program; offset of Medicare payments to individuals to collect past-due obligations arising from breach of scholarship and loan contracts--HCFA. Final rule.

    PubMed

    1992-05-04

    This final rule sets forth the procedures to be followed for collection of past-due amounts owed by individuals who breached contracts under certain scholarship and loan programs. The programs that would be affected are the National Health Service Corps Scholarship, the Physician Shortage Area Scholarship, and the Health Education Assistance Loan. These procedures would apply to those individuals who breached contracts under the scholarship and loan programs and who-- Accept Medicare assignment for services; Are employed by or affiliated with a provider, Health Maintenance Organization, or Competitive Medical Plan that receives Medicare payment for services; or Are members of a group practice that receives Medicare payment for services. This regulation implements section 1892 of the Social Security Act, as added by section 4052 of the Omnibus Budget Reconciliation Act of 1987.

  9. 27 CFR 26.267 - Payment of tax by electronic fund transfer.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... VIRGIN ISLANDS Procedure at Port of Entry From the Virgin Islands § 26.267 Payment of tax by electronic fund transfer. (a) Each person bringing liquors and articles into the United States from the Virgin... liquors and articles into the United States from the Virgin Islands who is required, by this section, to...

  10. 42 CFR 413.180 - Procedures for requesting exceptions to payment rates.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... the basis of prior year costs and utilization trends that it has an allowable cost per treatment... requesting an exception to its payment rate, it must submit to CMS its most recently completed cost report as... be needed to adjudicate each type of exception. CMS may audit any cost report or other information...

  11. 42 CFR 413.180 - Procedures for requesting exceptions to payment rates.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... the basis of prior year costs and utilization trends that it has an allowable cost per treatment... requesting an exception to its payment rate, it must submit to CMS its most recently completed cost report as... be needed to adjudicate each type of exception. CMS may audit any cost report or other information...

  12. 42 CFR 413.180 - Procedures for requesting exceptions to payment rates.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... the basis of prior year costs and utilization trends that it has an allowable cost per treatment... requesting an exception to its payment rate, it must submit to CMS its most recently completed cost report as... be needed to adjudicate each type of exception. CMS may audit any cost report or other information...

  13. 42 CFR 413.180 - Procedures for requesting exceptions to payment rates.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... the basis of prior year costs and utilization trends that it has an allowable cost per treatment... requesting an exception to its payment rate, it must submit to CMS its most recently completed cost report as... be needed to adjudicate each type of exception. CMS may audit any cost report or other information...

  14. 26 CFR 1.7519-2T - Required payments-procedures and administration (temporary).

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... should type or legibly print “zero” on the appropriate line of the prescribed form. (3) Time and place... termination of the section 444 election. (d) Negligence and fraud penalties made applicable. For purposes of section 6653, relating to additions to tax for negligence and fraud, any payment required by this section...

  15. 42 CFR 412.48 - Denial of payment as a result of admissions and quality review.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... admission of an individual patient is denied by a QIO under paragraph (a)(1) of this section, and liability... provided under procedures established by CMS to implement the provisions of section 1155 of the Act, Right... circumventing the prospective payment systems, is referred to the Department's Office of Inspector General, for...

  16. 42 CFR 412.48 - Denial of payment as a result of admissions and quality review.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... admission of an individual patient is denied by a QIO under paragraph (a)(1) of this section, and liability... provided under procedures established by CMS to implement the provisions of section 1155 of the Act, Right... circumventing the prospective payment systems, is referred to the Department's Office of Inspector General, for...

  17. 42 CFR 412.48 - Denial of payment as a result of admissions and quality review.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... admission of an individual patient is denied by a QIO under paragraph (a)(1) of this section, and liability... provided under procedures established by CMS to implement the provisions of section 1155 of the Act, Right... circumventing the prospective payment systems, is referred to the Department's Office of Inspector General, for...

  18. 42 CFR 412.48 - Denial of payment as a result of admissions and quality review.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... admission of an individual patient is denied by a QIO under paragraph (a)(1) of this section, and liability... provided under procedures established by CMS to implement the provisions of section 1155 of the Act, Right... circumventing the prospective payment systems, is referred to the Department's Office of Inspector General, for...

  19. 42 CFR 412.48 - Denial of payment as a result of admissions and quality review.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... admission of an individual patient is denied by a QIO under paragraph (a)(1) of this section, and liability... provided under procedures established by CMS to implement the provisions of section 1155 of the Act, Right... circumventing the prospective payment systems, is referred to the Department's Office of Inspector General, for...

  20. 12 CFR 811.7 - Servicing book-entry Federal Financing Bank securities; payment of interest; payment at maturity...

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 12 Banks and Banking 7 2014-01-01 2014-01-01 false Servicing book-entry Federal Financing Bank... FEDERAL FINANCING BANK BOOK-ENTRY PROCEDURE FOR FEDERAL FINANCING BANK SECURITIES § 811.7 Servicing book... becoming due on book-entry Federal Financing Bank securities shall be charged against the special agent...

Some links on this page may take you to non-federal websites. Their policies may differ from this site.
Top