Example No: 1. Dr. Jones received $3,000 a year from Hospital X for services other than direct medical services to all patients, for example, utilization review and administrative services. Dr. Jones also voluntarily furnished direct medical services to beneficiaries. The imputed value of the volunteer services amounted to $10,000 for the cost reporting period. The full imputed value of Dr. Jones' volunteer direct medical services would be allowed since the total amount of the imputed value ($10,000) and the compensated services ($3,000) does not exceed $30,000.
Example No: 2. Dr. Smith received $25,000 from Hospital X for services as a department head in a teaching hospital. Dr. Smith also voluntarily furnished direct medical services to beneficiaries. The imputed value of the volunteer services amounted to $10,000. Only $5,000 of the imputed value of volunteer services would be allowed since the total amount of the imputed value ($10,000) and the compensated services ($25,000) exceeds the $30,000 maximum amount allowable for all of Dr. Smith's services.
Computation:
Maximum amount allowable for all services performed by Dr. Smith for purposes of this computation | $30,000 |
Less compensation received from Hospital X for other than direct medical services to individual patients | $25,000 |
Allowable amount of imputed value for the volunteer services furnished by Dr. Smith | $5,000 |
Example No. 3.
Dr. Brown is not compensated by Hospital X for any services furnished in the hospital. Dr. Brown voluntarily furnished direct surgical services to beneficiaries for a period of 6 months, and the imputed value of these services amounted to $20,000. The allowable amount of the imputed value for volunteer services furnished by Dr. Brown would be limited to $15,000 ($30,000 * 6/12).
Teaching Hospital Y
Statistical and financial data:
Total inpatient days as defined in paragraph (h)(2) of this section and outpatient visit days as defined in paragraph (h)(3) of this section | 75,000 |
Total inpatient Part A days | 20,000 |
Total inpatient Part B days where Part A coverage is not available | 1,000 |
Total outpatient Part B visit days | 5,000 |
Total cost of direct medical and surgical services furnished to all patients by physicians on the hospital staff as determined in accordance with paragraph (i) of this section | $1,500,000 |
Total cost of direct medical and surgical services furnished to all patients by physicians on the medical school faculty as determined in accordance with paragraph (i) of this section | $1,650,000 |
Computation of cost applicable to program for physicians on the hospital staff:
Average cost per diem for direct medical and surgical services to patients by physicians on the hospital staff: $1,500,000 ÷ 75,000 = $20 per diem.
Cost of physician direct medical and surgical services furnished to inpatient beneficiaries covered under Part A: $20 per diem * 20,000 | $400,000 |
Cost of physician direct medical and surgical services furnished to inpatient beneficiaries covered under Part B: $20 per diem * 1,000 | $20,000 |
Cost of physician direct medical and surgical services furnished to outpatient beneficiaries covered under Part B: $20 per diem * 5,000 | $100,000 |
Computation of cost applicable to program for physicians on the medical school faculty:
Average cost per diem for direct medical and surgical services to patients by physicians on the medical school faculty: $1,650,000 ÷ 75,000 = $22 per diem.
Cost of physician direct medical and surgical services furnished to inpatient beneficiaries covered under Part A: $22 per diem * 20,000 | $440,000 |
Cost of physician direct medical and surgical services furnished to inpatient beneficiaries covered under Part B: $20 per diem * 1,000 | $22,000 |
Cost of physician direct medical and surgical services furnished to outpatient beneficiaries covered under Part B: $22 per diem * 5,000 | $110,000 |
Example: The physicians on the medical staff of Teaching Hospital Y donated a total of 5,000 hours in furnishing direct medical and surgical services to patients of the hospital during a cost reporting period and did not receive any compensation from either the hospital or the medical school. Also, the imputed value for any physician volunteer services did not exceed the rate of $30,000 per year per physician.
Statistical and financial data:
Total salaries paid to the full-time salaried physicians by the hospital (excluding interns and residents) | $800,000 |
Total physicians who were paid for an average of 40 hours per week or 2,080 (52 weeks * 40 hours per week) hours per year | 20 |
Average hourly rate equivalent: $800,000 ÷ 41,600 (2,080 * 20) | $19.23 |
Computation of total imputed value of physician volunteer services applicable to all patients:
(Total donated hours * average hourly rate equivalent): 5,000 * $19.23 | $96,150 |
Total inpatient days (as defined in paragraph (h)(2) of this section) and outpatient visit days (as defined in paragraph (h)(3) of this section) | 75,000 |
Total inpatient Part A days | 20,000 |
Total inpatient Part B days if Part A coverage is not available | 1,000 |
Total outpatient Part B visit days | 5,000 |
Computation of imputed value of physician volunteer direct medical and surgical services furnished to Medicare beneficiaries:
Average per diem for physician direct medical and surgical services to all patients: $96,150 ÷ 75,000 = $1.28 per diem
Imputed value of physician direct medical and surgical services furnished to inpatient beneficiaries covered under Part A: $1.28 per diem * 20,000 | $25,600 |
Imputed value of physician direct medical and surgical services furnished to inpatient beneficiaries covered under Part B: $1.28 per diem * 1,000 | $1,280 |
Imputed value of physician direct medical and surgical services furnished to outpatient beneficiaries covered under Part B: $1.28 per diem * 5,000 | $6,400 |
Total | $33,280 |
42 C.F.R. §415.162