Some healthcare providers rely on the Centers for Medicare & Medicaid Physician Fee Schedule to set their charges. This practice can have a serious impact on personal injury cases and settlements.
Veritas Experts follows the American Medical Association’s position that there is no relationship between the Medicare fee schedule and what constitutes “Usual, Customary, and Reasonable” fees (UCR).
Unfortunately, only some providers recognize that the CMS fee schedule is based on the small portion of the population that utilizes those programs. As a result, the data does not apply to all patients in every region.
The CMS Physician Fee Schedule
Over the years, Medicare reimbursement rates have remained flat or declined while inflation continues to rise. As a result, when providers use Medicare as the benchmark for setting their rates, their “chargemaster” can be far from an accurate reflection of market prices.
Poorly informed chargemasters can seriously impact a personal injury case.
Medical Billing and Benchmarking Databases
To avoid this, ask the providers involved in your cases if they consult with third-party medical billing professionals like those at Veritas Experts. Best practices encourage a thorough chargemaster audit at least once a year, though, with current market fluctuations, more frequent reviews may be necessary.
We excel at sourcing information from benchmarking databases to help healthcare providers set accurate chargemaster rates. By comparing the costs of services in the region, we help providers better understand what constitutes fair and reasonable rates for their practice.
More than just the provider’s geographic location, our experts also consider the type of services provided and the payer mix. Furthermore, our experts help providers see how different payer reimbursement rates may impact their overall pricing strategy.
Accurate Pricing, Better Outcomes
By understanding these factors, providers can develop a pricing strategy that accurately reflects the true market value of their services, ensuring the best possible care for their patients–and more positive outcomes for your personal injury cases.
Contact Veritas Experts today to learn more, and be sure to send the healthcare providers you work with our way. It’s a win-win.