decisionhealth Newsletters, Part B News - 2005 Issue 1 (January)
Make sure your charges don't lag behind Medicare allowables
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Article Overview
This short practice-management article explains why offices should periodically compare their charge structure with Medicare allowables after annual payment changes. It addresses general charge-setting strategy, the relationship between usual charges and reimbursement, and mentions Medicare compliance concerns discussed by billing experts and the OIG. The piece is aimed at healthcare administrators, billing staff, and coding/revenue cycle professionals who manage fee schedules and payer contracts.
Why This Topic Matters
Charge levels can affect Medicare reimbursement and contract negotiations, so practices need to know when their usual fees may be below allowable amounts and whether their charge patterns could raise compliance concerns.
What You Will Learn
- Why practices review charges when Medicare payments change
- How usual charge levels can affect reimbursement and payer negotiations
- What general Medicare-related charge consistency concerns are raised in the article
- Why fee-setting strategy matters for revenue cycle management
Who Should Read This
- Physician practice managers
- Medical billers and coders
- Revenue cycle staff
- Healthcare administrators
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