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Fee-for-service (FFS) is a payment model where services are unbundled and paid for separately. [1]In health care, it gives an incentive for physicians to provide more treatments because payment is dependent on the quantity of care, rather than quality of care.
The Omnibus Budget Reconciliation Act of 1989 enacted a Medicare fee schedule, and as of 2010 about 7,000 distinct physician services were listed. [2] The services are classified under a nomenclature based on the Current Procedural Terminology (CPT) to which the American Medical Association holds intellectual property rights. [2]
The rate of increase in both health insurance premiums and out-of-pocket costs have declined in the employer-based market. For example, premiums increased at an annual rate of 5.6% from 2000-2010, but 3.1% from 2010-2016. An estimated 155 million persons under the age 65 were covered under health insurance plans provided by their employers in 2016.
Health insurance became a conduit for billing, and it standardized fees by negotiating fee schedules, eliminating additional charges, and restricting discounts that the sliding scale offered. [7] For several decades, medical billing was done almost entirely on paper.
In 1988 the results were submitted to the Health Care Financing Administration (today CMS) to be used in the American Medicare system. In December of the following year, President George H. W. Bush signed into law the Omnibus Budget Reconciliation Act of 1989, switching Medicare to an RBRVS payment schedule. This took effect on January 1, 1992.
Health insurers determine what they deem to be "usual, customary and reasonable" and pay only a percentage of that. [ 4 ] Under an early version of this system based on Resource-Based Relative Value Units , physician services were largely considered to be misvalued, with evaluation and management services being undervalued and procedures ...
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Fee-for-service is a payment model in which services are unbundled and paid for individually. In health care, it gives an incentive for physicians to give more treatments because payment is depending on the quantity, rather than quality of care. However evidence of the effectiveness of FFS in improving health care quality is mixed, without ...