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) .

Highest and best estate, by which an owner is entitled to the entire property without limitations or conditions, as are his or her heirs.

1. Method of payment in which the patient pays the physician for each professional service or procedure performed from an established schedule of fees. 2. Condition when the third-party payer pays the full fee for medical services. 3. In managed care plans, reimbursement for professional services on a service-by-service basis rather than by the capitation method. FFS reimbursement may involve either discounted or undiscounted rates. 4. Plan or primary care case management (PCCM) is paid for providing services to enrollees solely through fee-for-service payments plus a case management fee.

Quantitative measure of the difference between the amount a physician receives from a managed care capitation system compared with fee-for-service payment.

Specified period of time, usually 12 months, in which supplementary medical insurance–recognized fees pertain. The fee-screen year period has changed over the history of the Medicare program.

Federal workers who are members of the Federal Employee Health Benefits Program.

Insurance company’s local or regional sales offices.