Thursday, June 10, 2010

Other Payer Name - Loop 2330 B

Loops and Segments Table - Loop 2330B - Other Payer Name

Usage : Required
Element : NM101
Value : PR = Payer
Comment : Code to identify an organizational entity or other payer.


Usage : Required
Element : NM102
Value : 2= Nonperson Entity
Comment : Code to identify type of entity.


Usage : Required
Element : NM103
Value : Nil
Comment : Name Last or Organization Name.


Usage : Required
Element : NM108
Value :
 PI = Payer Identification
XV = Health Care Financing Administration National Plan ID

Comment : Code to identify Payer or organization.


Usage : Required
Element : NM109
Value : Nil
Comment : Payer Identification Code.
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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