Ama Policy

Payment for Physicians Services H-385.989

Fee Schedules
Our AMA:
(1) supports a pluralistic approach to third party payment methodology under fee-for-service, and does not support a preference for “usual and customary or reasonable” (UCR) or any other specific payment methodology;
(2) affirms the following four principles:
(a) Physicians have the right to establish their fees at a level which they believe fairly reflects the costs of providing a service and the value of their professional judgment.
(b) Physicians should continue to volunteer fee information to patients, to discuss fees in advance of service where feasible, to expand the practice of accepting any third party allowances as payment in full in cases of financial hardship, and to communicate voluntarily to their patients their willingness to make appropriate arrangements in cases of financial need.
(c) Physicians should have the right to choose the basic mechanism of payment for their services, and specifically to choose whether or not to participate in a particular insurance plan or method of payment, and to accept or decline a third party allowance as payment in full for a service.
(d) All methods of physician payment should incorporate mechanisms to foster increased cost-awareness by both providers and recipients of service; and
(3) supports modification of current legal restrictions, so as to allow meaningful involvement by physician groups in:
(a) negotiations on behalf of those physicians who do not choose to accept third party allowances as full payment, so that the amount of such allowances can be more equitably determined;
(b) establishing additional limits on the amount or the rate of increase in charge-related payment levels when appropriate; and
(c) professional fee review for the protection of the public.

Policy Timeline

CMS Rep. A, A-84 Reaffirmed by CLRPD Rep. 3 – I-94 Reaffirmed: Sub. Res. 716, A-00 Reaffirmation A-02 Reaffirmation A-07 Reaffirmed in lieu of Res. 127, A-10 Reaffirmation I-13 Reaffirmation A-15