WILLIAM DONALD SCHAEFER, Governor                                Ch. 9

(I) A NUMERIC FACTOR REPRESENTING THE RESOURCES OF THE
HEALTH CARE PRACTITIONER NECESSARY TO PROVIDE HEALTH CARE SERVICES;

(II)     A NUMERIC FACTOR REPRESENTING THE RELATIVE VALUE OF A
HEALTH CARE SERVICE. AS CLASSIFIED BY C.P.T. CODE, COMPARED TO THAT OF OTHER
HEALTH CARE SERVICES; AND

(III)    A NUMERIC FACTOR REPRESENTING A CONVERSION MODIFIER
USED TO ADJUST REIMBURSEMENT.

(4) TO PREVENT OVERPAYMENT OF CLAIMS FOR SURGERY OR SERVICES, IN
DEVELOPING THE PAYMENT SYSTEM UNDER THIS SECTION, THE COMMISSION SHALL
ESTABLISH STANDARDS TO MINIMIZE THE UNBUNDLING OF C.P.T. CODES AND THE USE
OF REIMBURSEMENT MAXIMIZATION PROGRAMS, COMMONLY KNOWN AS "UPCODING".

(5) IN DEVELOPING THE PAYMENT SYSTEM UNDER THIS SECTION THE
COMMISSION SHALL CONSIDER THE UNDERLYING METHODOLOGY USED IN THE
RESOURCE BASED RELATIVE VALUE SCALE ESTABLISHED UNDER 42 U.S.C. § 1395W-4.

(C) (1) IN ESTABLISHING A PAYMENT SYSTEM UNDER THIS SECTION, THE
COMMISSION SHALL TAKE INTO CONSIDERATION THE FACTORS LISTED IN THIS
SUBSECTION.

(2) IN MAKING A DETERMINATION UNDER SUBSECTION (B)(3)(I) OF THIS
SECTION CONCERNING THE RESOURCES OF A HEALTH CARE PRACTITIONER NECESSARY
TO DELIVER HEALTH CARE SERVICES, THE COMMISSION:

(I) SHALL ENSURE THAT THE COMPENSATION FOR HEALTH CARE
SERVICES IS REASONABLY RELATED TO THE COST OF PROVIDING THE HEALTH CARE
SERVICE; AND

(II) SHALL CONSIDER:

1. THE COST OF PROFESSIONAL LIABILITY INSURANCE;

2. THE COST OF COMPLYING WITH ALL FEDERAL, STATE, AND
LOCAL REGULATORY REQUIREMENTS;

3. THE REASONABLE COST OF BAD DEBT AND CHARITY CARE;

4. THE DIFFERENCES IN EXPERIENCE OR EXPERTISE AMONG
HEALTH CARE PRACTITIONERS, INCLUDING RECOGNITION OF RELATIVE PREEMINENCE
IN THE PRACTITIONER'S FIELD OR SPECIALTY AND THE COST OF EDUCATION AND
CONTINUING PROFESSIONAL EDUCATION;

5.         THE GEOGRAPHIC VARIATIONS IN PRACTICE COSTS;

6,        THE REASONABLE STAFF AND OFFICE EXPENSES DEEMED
NECESSARY BY THE COMMISSION TO DELIVER HEALTH CARE SERVICES;

7. THE COSTS ASSOCIATED WITH A FACULTY PRACTICE PLAN
AFFILIATED WITH A TEACHING HOSPITAL; AND

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