Details on deductibles announced by HCFA
Details on deductibles announced by HCFA
4.5% overall fee increase taking effect
Medicare payments to physicians will increase by 4.5% during 2001, according to the Health Care Financing Administration (HCFA).
Also, as of Jan. 1, 2001:
• The fee schedule conversion factor is $38.2581.
• The fee schedule update is 5.1%.
• The national average anesthesia conversion factor is $17.26.
• The preliminary estimated sustainable growth rate is set at 5.6%.
This year also marks the third year of a four-year transition from a charge-based to a full-fledged resource-based relative value unit (RVU) payment system. By law, this means practice expenses will be paid at a 25% charge-based and 75% resource-based ratio during 2001. As part of this transition, year 2001 malpractice RVUs should be considered interim values because it is likely they’ll be revised once more current data are available.
Reminder: The Balanced Budget Act of 1997 says nurse practitioners, physician assistants, and clinical nurse specialists acting within the scope of state law can now bill for plan oversight services, provided physicians first certify and recertify the need for the home health services.
Part A and B deductibles for 2001
There will be $16 increase in the Medicare Part A deductible and a $4.50 increase in monthly Part B premiums for 2001, according to the HCFA. The Part A deductible for inpatient hospital care will rise to $792 in 2000, reflecting a 2% increase over 2000 rates. The Medicare Part B monthly premium will be $50 in 2001. The payment changes will become effective Jan. 1, 2001.
The Part A deductible is the amount the beneficiary must pay for up to 60 days of Medicare-covered inpatient hospital care. For the 61st day through the 90th, daily coinsurance is $198. Beyond the 90th day, the payment is $396 per day.
The skilled nursing facility daily coinsurance amount for the 21st through the 100th day of extended care is $99 a day.
The Part B premium covers physician services, hospital outpatient care, durable medical equipment, and other services outside hospitals. Part B premiums represent 25% of total Part B spending.
"While the increase for 2001 is necessary to cover higher costs and legislative changes, we have still succeeded in significantly holding down Part B beneficiary premiums over recent years," says Michael M. Hash, acting HCFA administrator. "Total premium increases for our beneficiaries have been less than half the amount originally projected when the Balanced Budget Act of 1997 was passed." In 2000, the Part B premium did not increase, and in 1999 the increase was only $1.70. The Part A deductible grew $8 in 2000.
The Part A premium, paid by seniors with less than 30 quarters of Medicare-covered employment and some beneficiaries with disabilities, will decrease by $1 to $300. Only 388,000 beneficiaries currently pay the deductible.
The cost for beneficiaries in hospital days 61 through 90 in a given benefit period will increase to $198, up by $4, and for hospital days beyond 90, the cost will increase $8 to $396. Daily coinsurance for skilled nursing facilities, which must be paid after the first 20 days of such care in a benefit period, will rise by $2, to $99 per day.
Beneficiaries with 30 to 39 quarters of Medicare-covered employment will pay a reduced monthly premium of $165, down $1 from 2000.
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