Billing > Billing

usuall and customary charges

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rdmoore2003:
How, if any, can you find and figure your areas usuall and customary charges for out of network, so that I can figure each client's percent?

PMRNC:
U&C is calculated using the HIAA at the 90th percentile, from 1997.. ( I think..)
Insurance carriers will NOT give out U&C

why do you need it to figure out what to charge? If you are charging on a percentage it should be on "total" revenue collected.

rdmoore2003:
I need to know so that out of network clients that are responsible for say 30% get charged correctly, I like to charge accurate fees and not just fly by like some billers that I have met around the country.

Pay_My_Claims:

--- Quote from: rdmoore2003 on July 03, 2009, 12:29:19 PM ---I need to know so that out of network clients that are responsible for say 30% get charged correctly, I like to charge accurate fees and not just fly by like some billers that I have met around the country.

--- End quote ---

Ok, now I am more confused. If you are billing according to your fee schedule, you can't charge and OON client more because they are OON. I don't know what kind of provider you are billing for, but since I do a lot of DME, I will use that.

In NC I will say a k0005 UCR is 2500. Our fee schedule is such that we bill (all payors) 2300 we are lower than what is usual in our area. Client A comes in for the chair has UHC (we are par) we still bill 2300 to the ins company and the client is still responsible for their portion after the INS company does its adjustments (allowable, ded, coins, pt resp). Client b comes in same chair with BCBS (non par) we still bill 2300 and bcbs will do the adjustments (allowable, ded, coins pt resp), but the DIFFERENCE is we can balance bill them since we are non-par.

PMRNC:
I'm confused too. Are you a biller? I'm still not understanding what knowing U&C has to do with charging your client. Anything above U&C on a charge is going to be patient responsibility..you are still charging/billing the patient and should be collecting the amounts over U&C or Copay for In network?

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