thanks all of you who answered my first question. my follow-up is do you pay lesser of charges or contract rate if the provider contract is silent? what is the industry practice?
Answers (2)
Barry - for physicians who have contract terms of a % of a standard fee schedule, industry practice from my experience is the lesser of charges or fee schedule.
In my experience, it is customary to pay the lesser of billed charges or the fee schedule. That was the policy of the organizations I've worked with in the past.
