Monday, May 24, 2010

Medicare payment floor and payment floor date.

MEDICARE PAYMENT FLOOR

The Medicare Payment Floor is the amount of time WPS Medicare has to wait before paying your claim. According to the Centers for Medicare & Medicaid Services (CMS) Internet-Only Manual (IOM) Pub. 100-04, Chapter 1, Sec. 80.2.1.2, "The 'payment floor' establishes a waiting period during which time the contractor may not pay, issue, mail, or otherwise finalize the initial determination on a clean claim. The "payment floor date" is the earliest day after receipt of the clean claim that payment may be made." Based on how you file claims, WPS Medicare will issue your remittance notice and check(s), if appropriate, according to the payment floor.

Type of Claim                                                        Payment Floor Date
HIPAA-compliant Electronic Claims                    14 calendar days from claim receipt date
Non-HIPAA compliant Electronic Claims             27 calendar days from claim receipt date
Paper Claims                                                       29 calendar days from claim receipt date
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Medicare physician fee schedule - Quick overview

Medicare Part B pays for physician services based on the PFS, which lists the more than 7,400 unique
covered services and their payment rates. Physicians’ services include the following:

* Office visits;
* Surgical procedures;
* Anesthesia services; and
* A range of other diagnostic and therapeutic services.


Medicare Physician Fee Schedule Payment Rates

Payment rates for an individual service are based on
three components:
1) Relative Value Units (RVU)
2) Conversion Factor (CF)
3) Geographic Practice Cost Indices (GPCI)


Medicare Physician Fee Schedule Payment Rates Formula


The Medicare PFS payment rates formula is shown below:

[(Work RVU x Work GPCI) + (PE RVU x PE GPCI) +
(MP RVU x MP GPCI)] x CF

Medicare fee schedule download