Changing views about "usual charges".
The OIG's new definition of "usual charges" could have a significant impact on payment rates for a hospital's services. Traditionally, "usual charges" has referred simply to non-discounted rates maintained in a hospital's charge description master. The OIG's definition of the term includes discounted rates that a hospital negotiates with commercial payers. If the OIG's definition is adopted, payers may attempt to apply it, thereby complicating rate setting negotiations and monitoring of contract compliance.
Fedor
Frank P
FP
Murphy Austin Adams Schoenfeld, LLP, Sacramento, Calif., USA. ffedor@murphyaustin.com
D000368:Aged; D005377:Financial Management, Hospital / Q000331:legislation & jurisprudence*; D017722:Hospital Charges / Q000145:classification*; D006801:Humans; D007349:Insurance, Health, Reimbursement; D008329:Managed Care Programs / Q000191:economics*; D006278:Medicare / Q000331:legislation & jurisprudence*; D011907:Rate Setting and Review; D014481:United States; D014483:United States Dept. of Health and Human Services