No matter what amount a provider charges for a given service, each third-party payer will establish the amount they will pay based on what is considered:
A) medically appropriate.
B) usual and ordinary.
C) usual, customary, and reasonable.
D) average.

Question

Quizplus · Accepted Answer

Third-party payers establish the amount they will pay based on what is considered usual, customary, and reasonable (UCR). UCR refers to the customary fee charged for a particular medical service in a certain area as well as the reasonable cost of that service. The medical appropriateness or average cost of a service does not necessarily determine the amount that the third-party payer will cover.

No Matter What Amount a Provider Charges for a Given