Physician's Capitation Trends-Magistrate nixes 'down payment' challenge
Physician's Capitation Trends-Magistrate nixes 'down payment' challenge
A federal magistrate has ruled that Medicare acted reasonably when it decided to use 1998 rather than 1992 as the base year for calculating the so-called "down payment" which kicks off a four-year transition to Medicare's new relative value-based fee schedule.
Eleven provider specialty organizations had challenged the decision, arguing that the Health Care Financing Administration did not have the authority to take the action it did. They also argued that federal law required that the earlier 1992 time frame be used as the base year.
The difference between the two dates translates into nearly $500 million in additional payments to primary care-oriented doctors during base year transition, which mainly came out of the pockets of surgical specialties. Also, the later date acts as a multiplier increasing future payments to office-based practices at a faster rate than if 1992 as used.
While awaiting the final decision from the U.S. District Court in Chicago, specialty groups are also waging what some consider to be an uphill battle to convince Congress to delay implementation of the practice expense transition process.
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