THE FEE SCHEDULE IN THE MEDICARE FACILITY VS NON FACILITY
Medicare facility basically means the medical care carried out in the established health facilities lie the hospitals, clinics and many others. Non-facility on the other hand is simply the health care administered to the person in other places like home based medical care, or office among others. The fee in these two places are different as spelt out by the current procedural terminologies code (CPT) which is a medical code set that is maintained by the American Medical Association using the CPT editorial panel. In case of a claim, therefore you need to state where exactly the service was offered to you.
The components of CPT code
When you lay a claim for your insurance to pay your medical bills. The amount in which the physician must be paid is determined by the relative value units, which is a tool that aids in the medical practice management to determine how much he or she should be paid for a service or even to make a decision on taking a buyout offer out of the hospital system. These relative value units have three components namely:
Work related value unit. This is the amount of work that the physician has done to restore the health of a patient. The amount of work is determined by how long he or she has worked. The complications that he or she was trying to solve, the technical skills that was required for him to do the job, the amount of stress that the physician was subjected to in course of the work and the mental effort that he or she required to solve the problem. When all these factors are considered, the medical practitioners pay is calculated and thus he or she gets what he or she has deserved.
Practices Expense. This is basically the expense that the medical personnel has gone in order to treat a patient. This is measured by the amount of drugs used and their costs, whether he or she has travelled to treat a patient, the value of the amount of time that he or she has spent to treat the patient among many others. This therefore helps the practitioner from suffering losses by covering his or her expenses.
Malpractice insurance. This is the insurance taken in case the medical personnel do not do the work effectively. You need to protect yourself from any eventuality like in case of a surgery. You therefore need to take the insurance. If there is no malpractice in the treatment, the medical personnel can be allocated some funds.
When treatment is carried out in the hospital or other medical facility, the schedule fee is lower than the non-facility one. This is caused by the fact that the practice does not undergo overhead expenses, staff, equipments, and also supplies.