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Viewing:  Aug 24, 2019

UCR Fees

UCR (Usual, Customary, and Reasonable) pricing is a method of generating healthcare pricing based on the average price charged in a particular geographic location. Gathering information on pricing is based on what other providers in the area are charging and is commonly used for a fee or payment reference, as it gives a basis on what is considered customary and reasonable.

If a provider is not contracted or in the absence of a contract, providers can set their fees and are entitled to a reasonable value for the service provided. It is important to get your UCR data from a reliable source to arrive at a reasonable value.

Find-A-Code offers UCR fees gathered from the VA or US Department of Veterans Administration; this information can be found on the code information page (see example bellow) and is offered as a fee comparison with our UCR Pricing add-on. Simply find your code and scroll down to Fees and open the tab titled “UCR Fees”, the fees will be displayed for UCR, Workers Comp, as well as Medicare Billed and Allowed.

 

VA Data sources include CMS RBRVS, MedPar, FairHealth, MarketScan, Milliman and others. The list of sources (as of 4/1/2019) is https://www.va.gov/COMMUNITYCARE/docs/RO/datasourcesv3p25.pdf .
 
When percentiles are used, yes they appear to consistently be 80% percentiles
NOTE: the majority of the sources come from RBRVS.

 

Find-A-Code's Tools & Resources

Pro-Fee Calculator- Medicare/UCR reimbursement

Calculate Medicare and UCR fees with Modifier adjustments

Unlimited Fee Reports

Compare your fees with Medicare, OWCP, VA's UCR

Webinar- The Importance of Fee Schedules

The importance of gathering organizing and using fee schedules

UCR Pricing, What is it?

Read this short article on what UCR is and where it comes from

Additional Links and Resources

VA.gov Reasonable Charges Data Sources

Sorted by charge type

UCR Fees Articles

Click the article title to view a summary and link to the full article.

So How Do I Get Paid for This? APC, OPPS, IPPS, DRG?

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You know how to find a procedure code and you may even know how to do the procedure, but where does the reimbursement come from?  It seems to be a mystery to many of us, so let's clear up some common confusion and review some of the main reimbursement systems.  One of the ...

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No Good Deed Goes Unpunished

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You simply need to read the headlines, posts, and tweets, about providers across the healthcare profession being audited, fined, and some even convicted, to see that the costs of non-compliance are real. We tell ourselves, “It won’t happen to me.” The reality is that it easily could. Your license is your livelihood.

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CMT Fees in 2019

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Now is the time to prepare. There were some minor reductions to the RVUs for CMT codes 90840-90843. Check here to see what those changes are.

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Are you Ready for CMS' 2019 Medicare Physician Fee Schedule Final Rule?

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The waiting is over, the Final Rule for CMS' 2019 Medicare Physician Fee Schedule (MPFS) is available - all 2,379 pages for those looking for a little light reading. As anticipated, there are some pretty significant changes. Most of us were carefully watching the proposed changes to the Evaluation and ...

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Wolters Kluwer Drug Pricing

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Wolters Kluwer provides unit and package pricing for multiple drug price types: Average Wholesale Price (AWP), Wholesale Acquisition Cost (WAC), Direct Price (DP), Manufacturer's Suggested Wholesale Price (SWP), Centers for Medicare & Medicaid Services, Federal Upper Limit (CMS FUL), Average Average Wholesale Price (AAWP), Generic Equivalent Average Price (GEAP). Average...

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Pricing for ASC’s and APC’s

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For Medicare purposes, an Ambulatory Surgical Center Resources (ASC) is a distinct entity that operates exclusively to furnish surgical services to patients who do not require hospitalization and in which the expected duration of services does not exceed 24 hours following admission. ASC payment groups determine the amount that...

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Routine Waiver of Patient Out of Pocket Expenses

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Medical billers often encounter the dilemma of a physician who wants to be the hero to his or her patients and waive their out-of-pocket expenses. Out-of-pocket expenses include a patient's co-payment, coinsurance, deductibles, charges above U&C (Usual and Customary), and even services a plan may not cover in some situations....

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New Bipartisian Budget Act of 2018 Provisions

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On February 9, 2018, the Bipartisan Budget Act of 2018 was signed into law. There were some changes which will affect Medicare payments. The following is a brief summary, for a more comprehensive summary see the References. Therapy Caps: Some therapy caps (e.g., occupational, physical therapy, speech-language pathology) were discontinued. However, modifier KX will ...

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Payment Rates Increase for Behavioral Health Office Services

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Behavioral health providers may see some improvement in payment rates for office-based behavioral health services. This is due to the fact that the overhead expense evaluation portion of the RVU was increased. The following information is from the Federal Register (see References): We agree with these stakeholders that the site of service ...

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Don’t Be Hesitant About Collecting Co-Pays

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If you are hesitant about collecting co-pays, consider that you may be paying interest on credit cards, property mortgages, and business loans. Each dollar that you do not collect in co-pays could have been used to pay down the practice debt. Without question, if you are having difficulty finding ways ...

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Adjusting Your Collection Strategies to HDHPs

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High Deductible Health Plans (HDHPs) are recent and growing trend in healthcare that is probably here to stay, regardless of the future changes to the national healthcare system or federal regulations.....

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UCR Pricing, What is it?

|

UCR (Usual, Customary, and Reasonable) pricing is a method of generating healthcare pricing based on the average pricing in a particular geographic location.  Gathering information on pricing based on what other providers in that area is charging is commonly used for a fee or payment reference, as it gives a basis ...

Read the article →

MIPS - To Participate or Not Participate - That is the Question

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Medicare’s Merit-based Incentive Payment System (MIPS) Final Rule increased the threshold for participation. With this increase, a significant number of providers fall into the exempt category and they are now breathing a sigh of relief. However, there’s one hidden tidbit which you may have missed - the potential damage to ...

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UCR Fees Tips


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UCR Fees Webinars

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What is RBRVS and How Can It Benefit Your Organization

What is RBRVS and How Can It Benefit Your Organization

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The Importance of Gathering Organizing and Using Fee Schedules

The Importance of Gathering Organizing and Using Fee Schedules

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