decisionhealth Newsletters, Answer Books - 2009 Issue 2 (February)
Fraud Alerts / OIG Special Fraud Alerts / Special Fraud Alert_May 1991 / Charge-based providers and reasonable charges
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Article Overview
This premium article reviews a legacy Medicare payment topic from an OIG Special Fraud Alert focused on charge-based providers. It explains the broad framework used to assess whether charges were considered reasonable under Medicare at the time, and it is relevant to compliance, reimbursement, and historical policy research for providers and billing professionals.
Why This Topic Matters
Understanding older Medicare payment frameworks can help compliance teams, auditors, and coders interpret historical claims issues and policy references. It may also be useful for organizations reviewing archived guidance or comparing past charge-based payment concepts with later fee schedule-based systems.
What You Will Learn
- The historical Medicare concept of charge-based provider payment
- The general categories used to evaluate whether a charge was considered reasonable
- How the article situates the guidance within a Special Fraud Alert and Medicare policy context
- Why this legacy guidance may still matter for compliance and audit review
Who Should Read This
- Medical coders
- Billing specialists
- Compliance professionals
- Revenue cycle staff
- Auditors
- Healthcare administrators
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