BC Advantage - 2006 Issue 1

Ways to deal with

How many times have you received reduced payment on claims for charges that are "above usual and customary"? Many insurance companies get their payment data from Ingenix and use the 80th percentile to determine how much they will pay for a specific CPT code. Anything billed over that amount is denied as above usual and customary. Our company always fights these denials. When the usual and customary reduction occurs on claims from insurance companies that my clients do not participate with, we bill the balance to the patient and one of two outcomes usually occurs: (1) the patient gets...

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