You ask a very good question. And while HMO usually dictates the price that they are willing to compensate for visits/procedures, they usually base it on what the federal government (Medicare) pays. And no, the vast majority of medical schools (MD or DO) do not teach or even hint about how physicians are paid (or the business of medicine). Only a few even talk about the Stark and Stark 2 laws.
Anyway, a good site to start is the Center for Medicare and Medicaid Services (CMS) - subdivision of HHS that you will get to know quite well once you are done with your training. And since it's the federal government involved in setting fee schedules, you can guess that it is highly convoluted, complex, confusing, non-sequitur, stupid, with layers and layers of red tape and traps (ie., committee work on steroids)
However, if you choose to charge "cash" for your services/procedures, then your reimbursement is based purely on what your patients are willing to pay. (if someone wants to pay $500 for OMM aimed at the lumbar region, then you can charge $500 for OMM)
http://www.cms.hhs.gov/apps/pfslookup/step0.asp
Medicare Physician Fee Schedule
This website is designed to provide information on services covered by the Medicare Physician Fee Schedule (MPFS). It provides more than 10,000 physician services, the associated relative value units, a fee schedule status indicator, and various payment policy indicators needed for payment adjustment (i.e., payment of assistant at surgery, team surgery, bilateral surgery, etc.).
The Medicare physician fee schedule pricing amounts are adjusted to reflect the variation in practice costs from area to area. A geographic practice cost index (GPCI) has been established for every Medicare payment locality for each of the three components of a procedure's relative value unit (i.e., the RVUs for work, practice expense, and malpractice). The GPCIs are applied in the calculation of a fee schedule payment amount by multiplying the RVU for each component times the GPCI for that component.
This site is designed to take you through the selection steps prior to the display of the information.
The site allows you to:
- search pricing amounts, various payment policy indicators, RVUs, and GPCIs by a single procedure code, a range and a list of procedure codes.
- search for the nation, a specific carrier, or a specific carrier locality. Each page has associated Help/Hint available to complete your selections.
