Newest Launch - We Now Have Outpatient Facility Pricing!

June 15th, 2020 - Christine Woolstenhulme, QCC, CMCS, CPC, CMRS
0 Votes - Sign in to vote or comment.

Our newest feature launch offers UCR pricing for Outpatient Facility. We recently released pricing information based on databases of insurance claims from private-sector health care providers.

Usual, customary, and reasonable charges (UCR) are medical fees used when there are no contractual pricing agreements and are used by certain healthcare plans and third-party payers to generate fair healthcare pricing.

Outpatient Facility pricing is the pricing charged by the facility in an outpatient setting. We also offer professional fees for UCR which are available with your UCR package. Outpatient Facility pricing is found under our fees section on any CPT code information page, then select the UCR Fees (green bar).

Notice the fees reflect the National Unadjusted fees in one column and the Geographic location using the zip code from your account settings in the other column (the location settings may be previously set up under your account).  

Another feature requested by our customers is the ability to adjust the fees according to the desired percentage. This can be changed according to the customers' needs at any time. The 100%  pricing still reflects the Geographically-adjusted or national un-adjusted charges and the 80th percentile conversion factors, however, we are offering the ability to adjust the UCR fees if needed, If the differences are not required simply put a zero -0- in the box.    

NOTE: The fee data we offer comes from the Veterans Administration (VA). For more information on where the VA gets the information please visit the TOPIC page on UCR FEES

If you are not seeing a price for Outpatient Facility Pricing, verify how the code should be used. One way to verify this is to look under the Additional Code Information bar, for example; 

27134  Revision of total hip arthroplasty, is an inpatient-only code. This information is identified with a "Status C" code indicating this should be billed as inpatient. 

If you currently have our Facility Base product and our UCR add-on, you can start using the Outpatient Facility Pricing today.

Please contact one of our Customer Success Managers at 801-770-4203 (9-5 Mountain), if you have any questions. 


Questions, comments?

If you have questions or comments about this article please contact us.  Comments that provide additional related information may be added here by our Editors.

Latest articles:  (any category)

HIPAA Penalty Changes
January 11th, 2021 - Wyn Staheli, Director of Research
On January 5, 2021, H.R. 7898 was signed into law by President Trump. This new law modifies the HITECH Act such that when an organization experiences a breach, fines and/or penalties may be reduced if (for at least a year) they have instituted “recognized security practices” as defined within the law.
CDT and CPT - The Same but Different!
December 8th, 2020 - Christine Woolstenhulme, QCC, QMCS, CPC, CMRS
Reporting a CPT code for an evaluation of a patient is based on time and if the patient is a new or established patient. Evaluation and Management codes are different than other codes, it is important to understand how they are used, prior to 2021 they were based on a ...
How to Search Find-A-Code for Medicare Policies and Guidelines — LCDs, NCDs and Articles —
November 18th, 2020 - Raquel Shumway
Help for Searching Find-A-Code when searching for Medicare Policies and Guidelines — LCDs, NCDs and/or Articles.
Cross-A-Code Instructions in Find-A-Code
November 18th, 2020 - Raquel Shumway
Cross-A-Codeis a toll found in Find-A-Code which helps you to locate codes in other code sets that help you when submitting a claim.
COVID Vaccine Codes Announced
November 11th, 2020 - Wyn Staheli, Director of Research
On November 10, 2020, the American Medical Association (AMA) announced the addition of two new codes which will be used for the new COVID-19 vaccines along with 4 new administration codes to be used when reporting the administration of these vaccines.
Are You Aware of the 2021 Star Rating System Updates?
November 5th, 2020 - Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content
Each year the Centers for Medicare & Medicaid Services (CMS) publishes the Star Ratings System Updates for Medicare Advantage (Part C) and Medicare Prescription (Part D). This rating system was developed to help beneficiaries identify and select the health plans that best meet their needs, specifically addressing main issues:  Quality of ...
Special Needs Plans Help Beneficiaries and Risk Adjustment Reporting
October 22nd, 2020 - Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content
It is no secret that Medicare and Medicaid are steadily moving towards their goal of value-based health care. Medicare Part C (Medicare Advantage) identifies and rewards payers, and subsequently their providers, for increasing the efficiency and quality of care they provide to Medicare...

Home About Contact Terms Privacy

innoviHealth® - 62 E 300 North, Spanish Fork, UT 84660 - Phone 801-770-4203 (9-5 Mountain)

Copyright © 2000-2021 innoviHealth Systems®, Inc. - CPT® copyright American Medical Association