Health maintenance organization that applies and meets the requirements of the Centers for Medicare and Medicaid Services (CMS) guidelines for Medicare reimbursement as set forth in the Health Maintenance Organization Act of 1973. Staff, group, and independent practice association (IPA) model HMOs are eligible for federal qualification under the federal HMO law. Network model HMOs are usually not eligible for qualification. FQHMOs are eligible for selection by a company of more than 25 employees and the company must offer two types (i.e., one IPA and one group or staff model HMO). This is known as the “dual choice mandate” of the HMO law. FQHMOs are eligible to contract with Medicare to be reimbursed on a per capita basis for an amount equal to 95% of its estimated cost for total health care services to that person during the year.
Insurance Encyclopedia
Fee
Dollar amount for professional services rendered to a patient by a provider.
Fee allowance
See: fee schedule .
Fee disclosure
Communication of medical charges with a patient by a provider or office manager before medical services and treatment are rendered.
Fee for service
Where a broker is remunerated on the basis of a fee agreed with its client instead of brokerage. The benefit to the broker is that, subject to the terms of agreement, the fee will be payable whether or not cover is placed whereas brokerage is only payable in respect of the placement of cover.
Fee for service reimbursement (Health Insurance)
A system wherein doctors and other health care professionals receive payment based on their charges for services provided.
Fee freeze
To fix prices at a given level or place for a specific period of time.
Fee maximum
See: fee schedule .
Fee maximum (Health Insurance)
The maximum fee available to a health care professional for a service provided under a contract.
Fee schedule
1. Listing in an insurance policy of procedure code numbers with charges or pre-established allowances for specific medical services and procedures. Also called table of allowances, fee allowance, fee maximum , benefit payment schedule, benefit schedule, schedule of allowances, schedule of benefits , or capped fee . 2. Record of procedure code numbers and services with dollar amounts, or payment amounts by a payer that could be percentages of billed charges, flat rates, or maximum allowable amounts set down by the managed care plan. 3. Annually published Medicare fee schedule (MFS) with procedure codes in the Federal Register ; applies to surgeries, clinical laboratory tests, radiological procedures, and durable medical equipment. The fees shown are the maximum dollar amounts Medicare will allow for each service rendered for a beneficiary. MFS is based on the calculation of several components including relative value unit (RVU), which is based on three factors: the physician’s work, overhead expenses, and malpractice insurance. Also called schedule . See also relative value studies (RVS) .