Medicare Fee Schedule HB 837
Effective 3/24/2023, Florida House bill 837 established medical payments to Doctors and healthcare facilities for medical treatments related to an injury will be reimbursed at 120% of the Medicare fee schedule.
A few statistics on using the Medicare fee schedule in the State of Florida.
Greater than 98% of non-pediatric physicians participate in Medicare.
Almost all surgeons participate in Medicare.
Participation in Medicare is a physician's choice, not mandatory.
The Medicare fee schedule has been a reimbursement standard for physician fees for several reasons:
Transparency: The Medicare fee schedule is transparent and publicly available, so physicians can understand how much they will be reimbursed for specific procedures and services.
Cost-based: The Medicare fee schedule is based on the average calculated medical service costs. The reimbursement rates are based on the costs of labor, equipment, and supplies required to provide a specific service, as well as the geographic location of the physician.
Standardization: The Medicare fee schedule standardizes reimbursement rates across different regions and specialties, so all physicians are reimbursed equally for their services.
Negotiated rates: Physicians have negotiated rates with private insurers based on the Medicare fee schedule. Managed care fee schedules range from below Medicare up to 180% of Medicare for certain specialties.
Cost containment: The Medicare fee schedule contains costs by setting reimbursement rates for medical services. The goal is to prevent the overutilization of medical services and to ensure that healthcare costs are sustainable over the long term. In 2022, 12% of the US federal spending was specific to Medicare. https://fiscaldata.treasury.gov/americas-finance-guide/federal-spending/#federal-spending-overview
Public Policy balance: Physicians and medical entities effectively become contractors for the government. Medicare established these rates to reimburse services that theoretically promote the health of people with disabilities and the older US population.
While many physicians complain Medicare reimbursements are low, very few voluntarily opt out of caring for the Medicare population.
At 120% of Medicare reimbursement, most accident-treating physicians will receive compensation at or higher than their current fee schedule because of the 2023 Florida Tort Reform.