Question

What are the definitions of facility and non-facility in Physician Fee Schedule?

1) Facility includes privately owned physician practices and non-facility includes hospital owned physician practices
2) Non-facility includes privately owned physician practices
3) Facility includes skilled nursing facilities, nursing homes, and hospital settings
4) Both B and C

Answer 1

The 'facility' setting for the Physician Fee Schedule includes institutional settings like hospitals, while 'non-facility' refers to private physician practices. Reimbursement rates differ between these settings to account for varying overhead costs.

Step-by-step explanation:

In the context of the Physician Fee Schedule, the terms facility and non-facility relate to the settings in which medical services are provided. A facility refers to locations such as skilled nursing facilities, nursing homes, and hospital settings where the overhead costs are typically higher, and integrated into the facility's billing. The non-facility setting includes privately-owned physician practices where overhead costs are not part of a larger institution's billing, such as a private hospital or a governmental agency like Health and Social Services.

This distinction is important because it affects the reimbursement rate for services; non-facility providers often receive higher reimbursement rates to cover their overhead costs which are not supported by larger institutional facilities.