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  2. Resource-based relative value scale - Wikipedia

    en.wikipedia.org/wiki/Resource-based_relative...

    The CPT Committee issues new codes twice each year. A separate committee, the Specialty Society Relative Value Scale Update Committee (RUC), [7] meets three times a year to set new values, [8] determines the Relative Value Units (RVUs) for each new code, and revalues all existing codes at least once every five years. The RUC has 29 members, 23 ...

  3. Relative value unit - Wikipedia

    en.wikipedia.org/wiki/Relative_value_unit

    On average, the proportion of costs for Medicare are 52%, 44% and 4%, respectively. [2] The three RVUs for a given service are each multiplied by a unique geographic practice cost index, referred to as the GPCI adjustment. The GPCI adjustment has been implemented to account for differences in wages and overhead costs across regions of the ...

  4. Explanation of benefits - Wikipedia

    en.wikipedia.org/wiki/Explanation_of_benefits

    adjustment reasons, adjustment codes; EOB documents are protected health information. Electronic EOB documents are called edi 835 5010 files. [2] There will normally also be at least a brief explanation of any claims that were denied, along with a point to start an appeal. [3]

  5. Prospective payment system - Wikipedia

    en.wikipedia.org/wiki/Prospective_payment_system

    In 2000, CMS changed the reimbursement system for outpatient care at Federally Qualified Health Centers (FQHCs) to include a prospective payment system for Medicaid and Medicare. [2] Under this system, health centers receive a fixed, per-visit payment for any visit by a patient with Medicaid, regardless of the length or intensity of the visit.

  6. Original Medicare vs. Medicare Advantage: Which should you ...

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    Original Medicare. 2024 cost. Part A. $0 in most cases, thanks to Medicare taxes from working 10 years or more. Part A deductible. $1,632 for every hospital benefit period, without any limits ...

  7. End Stage Renal Disease Program - Wikipedia

    en.wikipedia.org/wiki/End_Stage_Renal_Disease...

    Section 299I of Public Law 92-603, passed on October 30, 1972, extended Medicare coverage to Americans if they had stage five chronic kidney disease (CKD) and were otherwise qualified under Medicare's work history requirements. The program's launch was July 1, 1973. Previously only those over 65 could qualify for Medicare benefits.

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  9. Case mix index - Wikipedia

    en.wikipedia.org/wiki/Case_mix_index

    The number of cases for the hospitals ranges from a low of 1 to a high of 36,282 cases at Florida Hospital in Orlando, FL (Medicare ID 100007). That hospital has a Case Mix Index of 1.57. The mean number of cases across all the hospitals in the database is 3,098 with a standard deviation of 3,102.