Do you find that navigating your medical bills often feels like you’re trying to decipher a complex code? If so, you’re certainly not alone. The charges, terminology and variations in costs can often leave patients feeling both bewildered and financially burdened. This is where the crucial role of clinical experts in evaluating medical bills becomes paramount.
At Allegiant Experts, our clinical experts evaluate medical bills with extreme proficiency. We are experienced at determining the Usual, Customary and Reasonable charges (UCR) for like providers in specific geographic areas and Fair Market Value (FMV) reimbursement for like providers in the same geographic area.
What are Usual, Customary and Reasonable charges (UCR)?
Usual and Customary Charges refer to the typical fees that are charged by healthcare providers for a specific service or procedure within a geographic area. Understanding these charges helps us to assess whether or not a healthcare provider’s billing aligns with what is considered standard within that region. Our team of clinical experts analyzes UCR to ensure that patients are not overcharged or billed excessively for services that should fall within the average cost range.
“Usual, Customary and Reasonable (UCR) rates are used by insurance companies to determine what amount of a medical bill the insurance plan will cover,” explains Cancer Connect, “UCR rates are determined by geographic region and the specific service provided...Like all aspects of your health insurance policy, an understanding of UCR rates and how they impact your financial responsibility will help maximize your benefits while avoiding unexpected expenses.”
What is Fair Market Value (FMV)?
Fair Market Value reimbursement involves determining a reasonable payment for healthcare services. It is based on balancing the quality of care with the costs incurred by providers. The clinical experts at Allegiant Experts carefully assess FMV to ensure that healthcare reimbursements are fair and justifiable. We consider factors like provider expertise, resources utilized and the complexity of the services rendered.
As Alan Simons and Anne Clifford of CliftonLarsonAllen LLP inform, health care providers that accept payments from Medicare or Medicaid must make sure that exchanges between them and other providers are at FMV specializing in health care business valuation. If not, the providers could be excluded from these programs and subject to the Anti-Kickback Statute and the False Claims Act.
How do we protect patients from overbilling?
Incorrect billing or overcharging by healthcare providers can lead to financial strain and unnecessary stress for patients. Our clinical experts scrutinize medical bills to identify discrepancies. This ensures that patients are not unfairly burdened by inflated charges that surpass the UCR or FMV.
By having our team of clinical experts review medical bills, it gives patients insights into the intricacies of healthcare pricing. It allows them to advocate for themselves confidently, question billing discrepancies and seek fair resolutions. This process promotes transparency and accountability within the healthcare system.