decisionhealth Newsletters, Answer Books - 2008 Issue 5 (May)
Medicare_Carriers_Manual / 5002 / 5002
Subscribe or sign in to view the full article.
Article Overview
This Medicare Carriers Manual article addresses how reasonable charge is determined for covered services and how fee screen timing affects pricing. It is relevant to Medicare claims and reimbursement staff, carrier operations, and coding/billing professionals who need to understand the policy framework and administrative handling described in the manual.
Why This Topic Matters
The article outlines the policy basis used to evaluate charges and describes operational handling for annual pricing updates, which can affect reimbursement processing and claim payment timing.
Article Sections
-
5002. Criteria for Determining Reasonable Charge
This section covers the Medicare manual framework for assessing reasonable charge and the factors considered in that determination. It also addresses how annual fee screen timing is handled in pricing administration.
What You Will Learn
- The general criteria used to evaluate reasonable charge under Medicare carrier policy.
- How fee screen timing can affect the pricing basis for services.
- What operational considerations are described for annual pricing updates and claim handling.
- The type of administrative notice language associated with services spanning different fee screen years.
Who Should Read This
- Medicare claims professionals
- Medical coders
- Billing staff
- Revenue cycle teams
- Carrier operations personnel
Subscribe or sign in to view the full article.
Quick, Current, Complete - www.findacode.com