Why You Need a Medical Billing and Reimbursement Expert

February 2nd, 2017 UCR Rates Exceeded, Unbundling, Upcoding

Engaging a medical billing and reimbursement expert to determine and testify to the reasonable value of medical services, based on the provider’s location, is highly recommended.

Whether you are on the plaintiff or defense side, determining the cost of medical care can be complicated and the guidance of an expert is critical to ensure you have a clear understanding of what is “fair and reasonable.”

Fees: What is Usual, Customary & Reasonable?

UCR rates are the amount paid for a medical service, in a geographic area, based on what providers in the area usually charge for the same or similar medical service. UCR rates are an industry standard and accepted as appropriate reimbursement rates for medical services provided.

UThe Usual fee. This is a fee that is usually charged by the provider of a service or item.

CThe Customary fee. This is a fee that providers of the same specialty, in the same geographic area, charge for a service or item. It falls within a price range that other doctors in the area charge.

RThe Reasonable fee. This is for a service deemed necessary under the current conditions.