by Christine Woolstenhulme, QMC QCC CMCS CPC CMRS
Jan 25th, 2018
UCR (Usual, Customary, and Reasonable) pricing is a method of generating healthcare pricing based on the average pricing in a particular geographic location. Gathering information on pricing based on what other providers in that area is charging is commonly used for a fee or payment reference, as it gives a basis on what is considered customary and reasonable.
If a provider is not contracted or in the absence of a contract, providers can set their fees and are entitled to a reasonable value for the service provided. It is important to get your UCR data from a reliable source to arrive at a reasonable value. Find-A-Code offers UCR fees gathered from the VA or US Department of Veterans Administration; this information can be found on the code information page and is offered as a fee comparison with a fee analysis or the with Compare-A-Fee.
About Christine Woolstenhulme, QMC QCC CMCS CPC CMRS
Christine Woolstenhulme, CPC, QCC, CMCS, CMRS, is a Certified coder and Medical Biller currently employed with Find-A-Code. Bringing over 30 years of insight, business knowledge, and innovation to the healthcare industry. Establishing a successful Medical Billing Company from 1994 to 2015, during this time, Christine has had the opportunity to learn all aspects of revenue cycle management while working with independent practitioners and in clinic settings. Christine was a VAR for AltaPoint EHR software sales, along with management positions and medical practice consulting. Understanding the complete patient engagement cycle and developing efficient processes to coordinate teams ensuring best practice standards in healthcare. Working with payers on coding and interpreting ACA policies according to state benchmarks and insurance filings and implementing company procedures and policies to coordinate teams and payer benefits.