allowable charge

allowable charge

Managed care The lesser of the actual charge, the customary charge and the prevailing charge, which is the amount on which Medicare bases Part B payments

al·low·a·ble charge

(ă-lowă-bĕl chahrj)
Maximum payment amount to a provider per terms of a patient's policy.
References in periodicals archive ?
They also studied other flammable refrigerant leaks (R-290, R-32 and R-152a) for the sake of developing a new method for calculating the maximum allowable charge. A leak from a wall mounted, indoor room air conditioner (RAC) unit was studied numerically and experimentally for different refrigerants (R1234ze, R1234yf, R32 and R290) by Okamoto et al.
"Nonparticipating physicians could only charge a bit over the Medicare 'maximum allowable charge.'"
Routing is also a key consideration, to avoid routing refrigerant piping through smaller enclosed rooms with a lower maximum allowable charge. Operating pressures are relatively high, making the integrity of all the field joints critical, so enforce specification language requiring pressure testing of field piping.
For non-network providers, the outpatient cost-share is 20 percent of the Tricare allowable charge, and the inpatient cost-share is $16.85 per day ($25 minimum charge).
However, the blanket imposition of the maximum allowable charge will worry every family - and there will be many - for whom it represents a life-altering obligation.
Most providers have a pretty good idea of what the health plan's allowable charge is for routine services.
"If you bill the patient more than the maximum allowable charge under Medicare, you lose your license," said Dr.
Family members who use the point-of-service option are responsible for paying the annual deductible of $300 per member or $600 per family, and 50 percent of the TRICARE allowable charge once the deductible is met.
In most cases, the charge was far less than the maximum allowable charge, she said.
Your charges to Medicare should be the least expensive of your fees (but rationally, at least Medicare's allowable charge).
Once the deductible is met, the cost for additional POS care will be 50% of the CHAMPUS/TRICARE allowable charge. Any additional fees by nonnetwork providers are also your responsibility--up to 15% above the allowable charge, as permitted by federal law.
After the annual deductible is met, active-duty members pay 20% of the CHAMPUS allowable charge; all others pay 25%.