tci ED Coding & Reimbursement Alert - 1999 Issue 8

Keep Hospitals and Patients Happy: Pay Attention to ED Professional Fees to Attract Managed Care Contracts

Keep Hospitals and Patients Happy:Pay Attention to ED Professional Fees to Attract Managed Care Contracts Historically, ED physician groups have set fees using a number of strategies. Sometimes fees are based on what the hospital wants the physicians to charge, sometimes on what the physicians decide the services are worth. Until a few years ago, Medicare based its payments to physicians on the usual and customary charges for a particular code in a particular region of the country. Many private payers reimburse physicians according to a percentage of charges or an individual contracted amount per service. Consequently, emergency service...

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