HSA 305 Final Exam Terms (Chapters 5, 8, 11, and 13) Alternative payment model (APM) Payment approach that provides added incentives to deliver high-qual... [Show More] ity and cost-efficient care. Assignment of benefits A contract between a physician and Medicare in which the physician agrees to bill Medicare directly for covered services, to bill the beneficiary only for any coinsurance or deductible that may be applicable, and to accept the Medicare payment as payment in full. Medicare usually pays 80 percent of the approved amount directly to the provider of services after the beneficiary meets the annual Part B deductible. The beneficiary pays the other 20 percent (coinsurance). Geographic practice cost index (GPCI) Index based on relative difference in the cost of a market basket of goods across geographic areas. A separate GPCI exists for each element of the relative value unit (RYU), which includes physician work, practice expenses, and malpractice. GPC is are a means to adjust the RVUs, which are national averages, to reflect local costs of service. Health professional shortage areas (HPSAs) Areas that have a shortage of providers in medical care, dental care, or mental health, or some combination of these as designated by the US Health Resources and Service Administration. Malpractice (MP) element Element of the relative value unit (RYU); cost of the premiums for malpractice insurance and professional liability insurance. Medicare physician fee schedule (MPFS) The maximum amount of reimbursement that Medicare will allow for a service; consists of a list of payments for services defined by a service coding system (for example, the Healthcare Common Procedure Coding System [HCPCS]). Nonparticipating physicians (nonPARs) Physicians who treat Medicare beneficiaries but do not have a legal agreement with the program to accept assignment on all Medicare services and who, therefore, may bill
beneficiaries more than the Medicare reasonable charge on a service-by-service basis. Nonparticipating physicians receive 95 percent of the full Medicare physician fee schedule amount. Participating physician (PAR) Physician who signs an agreement with MEdicare to accept assignment for all services provided to MEdicare beneficiaries for the duration of the agreement. Physician work (WORK) element Element of the relative value unit (RVU) that should cover the physician's salary. This work is the time the physician spends providing a service and the intensity with which that time is spent. The four elements of intensity are: (1) mental effort and judgement, (2) technical skill, (3) physical effort, and (4) psychological stress Practice expense (PE) element Element of the relative value unit (RVU) that covers the physician's overhead costs, such as employee wages, office rent, supplies, and equipment. There are two types: facility and nonfacility Quality Payment Program (QPP) Payment incentive program for physician and eligible clinicians that links physician payment to quality measures and cost-saving goals. Relative value unit (RVU) Unit of measure designed to permit comparison of [Show Less]
