prevailing charge


Also found in: Dictionary, Thesaurus, Legal, Financial, Encyclopedia.

prevailing charge

The typical fee that a health care provider bills for a service, e.g., an office visit or a surgical procedure.
See also: charge
References in periodicals archive ?
The average allowed charge is used as the price level rather than either the submitted or prevailing charge since Medicare outlays are based primarily on allowed charges.
This last occurs to the extent that allowed charges are not all at the prevailing charge.
In early 1977, Colorado combined ten payment localities into a statewide locality, substantially changing the structure of Medicare's prevailing charges in each of the original localities.
2) If a physician's actual or customary charge for a service is less than his or her prevailing charge, then a reduction in the prevailing charge would be of no consequence financially to the physician in 1988.
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.
Further, Congress will implement across-the-board cuts in prevailing charge ceilings for 14 "overpriced" surgical procedures, without regard to a physician's participation status, The cuts will be at least 2 per cent and could go as high as 15 per cent, depending on how individual physician charges compare with weighted national averages.
The relatively slow growth in allowed charges in 1985 and 1986 appears to be related in part to limitations on prevailing charge increases imposed by the Deficit Reduction Act of 1984 and by the Emergency Extension Act of 1985 (Table 2).
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.
HCFA would seek to enact a national prevailing charge limit on all physician fees under Medicare.
Before the Deficit Reduction Act, Medicare paid 80 per cent of the prevailing charge for a test, and providers could collect a 20 per cent coinsurance payment from patients.
The payment level for hospital laboratories will be 62 per cent of the prevailing charge level for services provided to hospital outpatients.
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.