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Usual, customary, and reasonable (UCR) is an American method of generating health care prices, [1] described as "more or less whatever doctors decided to charge". [2] According to Steven Schroeder , Wilbur Cohen inserted UCR into the Social Security Act of 1965 "in an unsuccessful attempt to placate the American Medical Association ". [ 3 ]
Before RVUs were used, Medicare paid for physician services using "usual, customary and reasonable" rate-setting which led to payment variability. [2]The Omnibus Budget Reconciliation Act of 1989 enacted a Medicare fee schedule, and as of 2010 about 7,000 distinct physician services were listed. [2]
Both events have occurred during the history of utility regulation. The above goals attempt to serve the interests of the utility, its shareholders, consumers, and the general public. To be constitutional, a rate cannot be so high as to be confiscatory. Most state statutes further require rates to be just, reasonable, and non-discriminatory. [4]
Using the 2005 Conversion Factor of $37.90, Medicare paid 1.57 * $37.90 for each 99213 performed, or $59.50. Most specialties charge 200–400% of Medicare rates for their procedures and collect between 50 and 80% of those charges, after contractual adjustments and write-offs. [citation needed]
Cost-plus pricing is a pricing strategy by which the selling price of a product is determined by adding a specific fixed percentage (a "markup") to the product's unit cost.
Rate making, or insurance pricing, is the determination of rates charged by insurance companies. The benefit of rate making is to ensure insurance companies are setting fair and adequate premiums given the competitive nature.
The origin of the current rate schedules is the Internal Revenue Code of 1986 (IRC), [2] [3] which is separately published as Title 26 of the United States Code. [4] With that law, the U.S. Congress created four types of rate tables, all of which are based on a taxpayer's filing status (e.g., "married individuals filing joint returns," "heads of households").
Price points A, B, and C, along a demand curve (where P is price and Q represents demand). In economics, a price point is a point along the demand curve at which demand for a given product is supposed to stay relatively high.