67 %
33 %
Information about UCR
Business & Mgmt

Published on October 29, 2008

Author: karna.indian

Source: slideshare.net

Usual, Customary & Reasonable Fees Are Sometimes out of the Ordinary Have you ever submitted a claim to your insurance company for medical treatment, only to receive a letter from them stating the charge submitted was in excess of their usual, customary and reasonable fees? If so you're not alone What is a UCR fee? Insurance companies establish UCR fees. Here's how they do it. A quot;usualquot; fee is the fee that an individual physician most frequently charges for a specific medical procedure. A quot;customaryquot; fee is the fee level determined by the administrator of a medical benefit plan from actual fees submitted for a specific medical procedure. This fee establishes the maximum benefit payable for that procedure. A quot;reasonablequot; fee is the fee charged by a physician for a specific medical procedure that has been modified by complications or unusual circumstances. Therefore, it may differ from the physician's usual fee or the benefit administrator's customary fee. The concept of using UCR fees to determine how much to reimburse patients covered by medical insurance for specific treatment was introduced by the insurance industry in the early 1960s. How are UCR fees determined? UCR fees are influenced by the fees physicians charge in various geographic areas and by the population size. Usually, heavily populated areas, where the cost of living is higher, have higher medical fees. The Health Insurance Association of America (HIAA), an organization of 380 health insurance companies, surveys physicians every six months on their fees. The fee survey helps insurance companies set UCR fees. However, insurance companies are not legally required to use HIAA's fee survey or anyone else's information when setting UCR benefit levels. In fact, reimbursement calculations by insurance companies are unregulated and uncontrolled. How about UCR fees that don't cover all costs?

UCR rates may be outdated. Despite HIAA's attempts to update fee data to keep up with changing information. It may take up to two years for physicians to return HIAA's fee surveys, for HIAA to complete the data, and for member insurance companies and subscribers to receive it. Geographic differences may not be fairly taken into account when insurance companies set UCR rates. While boundaries are commonly set according to zip code, insurance companies are free to create boundaries as they choose. They may split a state in half or lump several small communities together to determine one boundary. If a large city and a small town are considered to be within the same boundary, large discrepancies in fees would exist. UCR fees widely vary among carriers. The Washington State Dental Association conducted a survey of 41 carriers on how they determine UCR fees; 28 responded. The data indicated that no two carriers use the same UCR definition. Carriers use different methods and different time frames to determine UCR rates. Customary fee determination made by carriers for the same procedure in the same city at the same time differed by as much as 136 percent. What accounts for the difference in physicians' fees and UCR rates? In addition to the limitations of UCR fees, any difference between the fee charged and the benefit paid is due to limitations in the patient's medical benefit contract.

Add a comment

Related presentations

Canvas Prints at Affordable Prices make you smile.Visit http://www.shopcanvasprint...

30 Días en Bici en Gijón organiza un recorrido por los comercios históricos de la ...

Con el fin de conocer mejor el rol que juega internet en el proceso de compra en E...

With three established projects across the country and seven more in the pipeline,...

Retailing is not a rocket science, neither it's walk-in-the-park. In this presenta...

What is research??

What is research??

April 2, 2014

Explanatory definitions of research in depth...

Related pages

Willkommen auf der Homepage des UCR e.V.

Der Zweck unseres Vereins ist - laut Satzung - die Durchführung von Veranstaltungen, die historische Ereignisse und Zustände aus den ...
Read more


Read more about UCR Announces New ARTSblock Director: Sheila Bergman. Sheila Bergman, who has more than 25 years of experience in non-profit management and ...
Read more


Termine Auswahl der UCR-Spartenleiter ; Forum aktuelle Event-Infos - Diskussionen; Verein Vorstand - Nachrufe - Satzung - JHV-Protokolle ...
Read more

About UCR

Main Navigation. Current page is: About UCR Home; Administration Meet the leaders of UCR; Rankings and Quick Facts Who we are, how we rate; UC System Learn ...
Read more

Unión Cívica Radical – Wikipedia

Die Unión Cívica Radical (abgekürzt UCR, spanisch Radikale Bürgerunion) ist die älteste noch existierende Partei in Argentinien. Sie wurde 1891 ...
Read more

UCR | Facebook

UCR. Facebook. Email or Phone: Password: Forgot account? See more of UCR by logging into Facebook. Message this Page, learn about upcoming events and more.
Read more

Unterwasserclub Rüsselsheim - Home

UCR - Unterwasserclub Rüsselsheim ... Herzlich Willkommen auf den Web-Seiten des Unterwasserclubs Rüsselsheim.
Read more

FBI — Uniform Crime Reporting - ucr.fbi.gov

The Uniform Crime Reporting (UCR) Program has been the starting place for law enforcement executives, students of criminal justice, researchers, members of ...
Read more

IN GOV UCR Application

Official UCR Board Certified Registration Site, $76 for 0 to 2 Vehicles; $227 for 3 to 5 Vehicles, $452 for 6 to 20 Vehicles; $1,576 for 21 to 100 Vehicles
Read more

Unterfarbenreduktion – Wikipedia

Unterfarbenreduktion, häufig auch mit dem englischen Begriff Under Color Removal (UCR) bezeichnet, ist ein Verfahren, das bei der Separation ...
Read more