BC Advantage - 2006 Issue 1
Ways to deal with
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Article Overview
This article explains how payment reductions can arise when insurers or workers’ compensation payors limit reimbursement based on usual-and-customary benchmarks. It focuses on practical claim-handling context, the difference between participating and non-participating insurance relationships, and a New Hampshire workers’ compensation issue involving state law and insurer payment methodology. The piece is useful for medical billers, practice managers, and providers who handle reimbursement denials and state-specific workers’ compensation claims.
Why This Topic Matters
Understanding how usual-and-customary reductions are applied can affect reimbursement strategy, claim appeals, and whether balances are pursued with patients or payors. The article also highlights why state workers’ compensation rules and fee schedules matter when evaluating reduced payments.
What You Will Learn
- How usual-and-customary payment reductions can affect claim reimbursement
- How non-participating and workers’ compensation claims differ in payment handling
- Why state workers’ compensation rules and fee schedules are relevant to reimbursement disputes
- How a state-level dispute can challenge an insurer’s payment methodology
Who Should Read This
- Medical billers
- Practice managers
- Healthcare providers
- Revenue cycle staff
- Workers’ compensation claim handlers
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