Outpatient Facility Coding Alert - 2009 Issue 9
Reader Questions: Don't Let Medicare Set Your Fees
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Article Overview
This article addresses a common practice-management question about whether Medicare’s payment levels should determine what a provider charges other payers. It is written for coders, billers, and practice staff who want general guidance on fee-schedule policy and payer contract considerations. The discussion stays at a high level and focuses on how fee setting and reimbursement relationships may differ across payers.
Why This Topic Matters
Understanding the relationship between fee schedules and payer reimbursement helps practices avoid setting charges based only on Medicare and supports more consistent billing policies across different contracts.
What You Will Learn
- How the article frames the relationship between a practice fee schedule and Medicare payment levels.
- Why payer reimbursement may differ from a practice’s charged amount.
- Which types of billing and compliance considerations are raised in a general reader-question format.
- How contract status can affect reimbursement at a broad level.
Who Should Read This
- Medical coders
- Medical billers
- Practice administrators
- Compliance staff
- Physician office staff
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