Medicare uses geographic adjustment factors—changes in reimbursement based on estimated operating expenses in different regions in the United States—to determine reimbursement for doctors and hospitals. The IOM is evaluating the accuracy of geographic adjustment factors and their effect on the health care workforce, quality of care, population health, and the ability to provide efficient ...
Medicare PFS Locality Configuration and Studies ... Home > Medicare > Physician Fee Schedule > Medicare PFS Locality Configuration and Studies Physician Fee Schedule. Physician Fee Schedule Look-Up Tool ... This report included an evaluation of the accuracy of geographic adjustment factors for the hospital wage index and the GPCIs, as well as ...
This adjustment factor is the wage index. We currently define hospital geographic areas (labor market areas) based on the definitions of Core-Based Statistical Areas (CBSAs) established by the Office of Management and Budget and announced in December 2003.
The Medicare system adjusts fee-for-service payment rates for hospitals and practitioners 1 according to the geographic location in which providers practice, recognizing that certain costs beyond the providers' control vary between metropolitan and nonmetropolitan areas and also differ by region. The fundamental rationale for geographic adjustment is to create a payment structure that adjusts ...
When they are combined, these three components are known as the geographic adjustment factor (GAF). 1. This chapter describes the history, intent, and evolution of the geographic practice cost indexes (GPCIs) to provide background and context for the committee's findings and recommendations about improving the accuracy of payment.
Medicare geographic adjustment factors have not significantly improved: –the level and distribution of the health care workforce and resources –primary care physician recruitment and retention –problems with access to health care in rural areas, or –the ability of physician offices, hospitals and other facilities to maintain an adequate and
Geographic Adjustment Factors Statutory Authority: Section 1848(e) of the Act Requires Secretary to create an index for each fee schedule area that reflects: –– relative cost of practice expenses (other than malpractice) to the national average (PE GPCI)
(a) Local cost variation. CMS adjusts for local cost variation based on the hospital wage index value that is applicable to the hospital under subpart D of this part. The adjustment factor equals the hospital wage index value applicable to the hospital raised to the .6848 power and is applied to 100 percent of the Federal rate. (b) Large urban location. ...
GAF geographic adjustment factor GPCI geographic practice cost index HUD Department of Housing and Urban Development MMA Medicare Prescription Drug, Improvement, and Modernization Act of 2003 MSA metropolitan statistical area OBRA Omnibus Budget Reconciliation Act of 1989 RVU relative value unit
Geographic Adjustment in Medicare Payment will inform the work of government agencies such as HHS, the Centers for Medicare and Medicaid Services, congressional members and staff, the health care industry, national professional organizations and state medical and nursing societies, and Medicare advocacy groups.