Page:United States Statutes at Large Volume 103 Part 3.djvu/116

 103 STAT. 2184 PUBLIC LAW 101-239—DEC. 19, 1989 Federal Register, publication. ices commonly performed by the physician, information on fee schedule amounte that apply for the year in the fee schedule area for participating and non-participating physicians, and the maxi- mum amount that may be charged consistent with subsection (gK2). Such information shall be transmitted in conjunction with notices to physicians under section 1842(h) (relating to the participating physi- cian program) for a year. "(i) MISCELLANEOUS PROVISIONS.— "(1) RESTRICTION ON ADMINISTRATIVE AND JUDICIAL REVIEW.— There shall be no administrative or judicial review under sec- tion 1869 or otherwise of— "(A) the determination of the historical payment basis (as defined in subsection (a)(2)(C)(i)), "(B) the determination of relative values and relative value units under subsection (c), "(C) the determination of conversion factors under subsection (d), "(D) the establishment of geographic adjustment factors under subsection (e), and "(E) the establishment of the system for the coding of physicians' services under this section. "0") DEFINITIONS. —In this section: "(1) CATEGORY.—The term 'category* means, with respect to physicians' services, surgical services, and all physicians' serv- ices other than surgical services, and such other category or cct^ories of physicians' services as the Secretary, from time to time, defines in regulation. The Secretary shall define surgical services and publish such definition in the Federal Register no later than May 1, 1990, after consultation with organizations representing physicians. (2) FEE SCHEDULE AREA.— The term 'fee schedule area' means a locality used under section 1842(b) for purposes of computing payment amounts for physicians' services. (3) PHYSICIANS' SERVICES.— The term 'physicians' services' includes items and services described in paragraphs (1), (2)(A), (2)(D), (3), and (4) of section 1861(s) (other than clinical diag- nostic laboratory tests and such other items and services as the Secretary may specify). "(4) PRACTICE EXPENSES.— The term 'practice expenses' in- cludes all expenses for furnishing ph3rsicians' services, exclud- ing malpractice expenses, physician compensation, and other physician fringe benefits.". (b) REQUIREMENTS FOR CARRIERS TO PROFILE PHYSICIANS. —Section 1842(b)(3) of such Act (42 U.S.C. 1395u(b)(3)) is amended— (1) by striking "and" at the end of subparagraph (J), (2) by inserting "and" at the end of subparagraph (K), and (3) by inserting after subparagraph (K) the following new subparagraph: "(L) will monitor and profile physicians' billing patterns within each area or locality and provide comparative data to physicians whose utilization patterns vary significantly from other physicians in the same payment area or locality;". (c) RURAL AND INNER-CITY ACCESS ADJUSTMENTS. — (1) ADJUSTMENTS. —Section 1833(m) of such Act (42 U.S.C. 13951(m)) is amended— (A) by striking "class 1 or class 2", and (B) by striking "5 percent" and inserting "10 percent".

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