Payment Methodology

70.2 - Payment Methodology (Rev. 1, 10-01-03) B3-4184.7, A-01-132 (CR 1914), A-01-105(CR 1783), B-01-46 (CR 1717) A/B MACs (B) pay for glaucoma screening based on the Medicare Physician Fee Schedule. Deductible and coinsurance apply. Claims from physicians or other providers where assignment was not taken are subject to the Medicare limiting charge, which means they cannot charge the beneficiary more than 115 percent of the allowed amount. A/B MAC (A) pay the facility expense as follows: • Independent and provider-based RHC/free standing and provider-based FQHC receive payment under the all- inclusive rate for the screening glaucoma service based on the visit furnished to the RHC/FQHC patient; • CAHs receive payment on a reasonable cost basis unless the CAH has elected the optional method of payment for outpatient services in which case, procedures outlined in Chapter 4 should be followed; • CORFs receive payment under the Medicare Physician Fee Schedule; • Hospital outpatient departments receive payment under the outpatient prospective payment system (OPPS); • Hospital inpatient Part B services are paid under OPPS; • SNF outpatient services are paid under the Medicare physician fee schedule (MPFS); and • SNF inpatient Part B services are paid under MPFS. Deductible and coinsurance apply.