In a time-series setting, what matters is not whether the share of the prevailing charge
is greater than that of the customary and the billed amounts combined, but whether the variations of the prevailing charge
over time are greater than those of the other two.
Of particular interest is the negative correlation between the size of the prevailing charge
reduction and average Medicare caseload.
Thus payments will now be 55 per cent of the prevailing charges
for independent labs and 57 per cent of those charges for hospital facilities.
Physicians are offered various incentives to sign participation agreements, including higher prevailing charge
levels and exclusion from the maximum allowable actual charges (MAAC) limits on NON-PAR physician charge.
Agency officials are attempting to tackle what they see as "grossly excessive" prevailing charges
for certain coverpriced" procedures.
Prevailing charge-The prevailing charge
is the charge at the 75th percentile in an array of the weighted customary charges made for similar services in the same locality.
Booth pointed out that HCFA and legislators zeroed in on the 60 per cent prevailing charge
level because "that seemed the point at which the Government could, in fact, reach some savings without being draconian."
Currently, Congress is considering a national fee schedule that would use a percentage (probably near 60 per cent) of the usual, customary, and prevailing charge
, in conrast to the demonstration project's RVS approach.
The House measure sets the fee schedule at 60 per cent of the prevailing charge
for the procedure and requires all clinical labs to bill Medicare directly.
Reasonable charges have been defined as " charges for services or supplies, which are standard charges for the specific provider and consistent with the prevailing charges
in the geographical area for identical or similar services." This is not the first time that the industry has expressed the need to standardise rates.
As per the usage, beneficiaries of this offer (the category of teachers and higher education students) must be subject to the prevailing charges
of Hayyak and Mada mobile broadband packages (3.5G) provided by Omantel.
Fee schedule was based on 60-62% of prevailing charges