While these data are available from the Prevailing Charge
file (BMAD-II), this file is not used since HCFA maintains that the data are not reliable.
Of particular interest is the negative correlation between the size of the prevailing charge
reduction and average Medicare caseload.
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.
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.
In the absence of unusual medical complications or circumstances, the reasonable charge is the lowest of (1) the physician's or supplier's actual charge, (2) the physician's or supplier's customary charge for that service, or (3) the prevailing charge
for the physicians or suppliers rendering the service in the same locality.
Agency officials are attempting to tackle what they see as "grossly excessive" prevailing charges
for certain coverpriced" procedures.
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.
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.