Locational Issues In Dealing with UCR Claims
Part 2, Chapter 4: Traditional Individual and Group Plans, Doctors' Bills Page 8
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One approach is to ask the insurer to make certain that the ZIP code used for the UCR analysis is correct. Since a UCR analysis is generally based on a database of statistical information related to providers' charges in a particular geographic area, the ZIP code that's used for the analysis is often very important. At times, errors may occur in terms of selecting the correct ZIP code. Such errors may be the result of a simple data entry error in which an incorrect ZIP code is unintentionally entered into the computer, or may result from confusion caused by a situation in which a doctor may have more than one office or may work out of both an office and a hospital.
In the latter case, it's important to make certain that the correct address -- the address of the office or hospital where the treatment was actually performed -- is used as the basis for the UCR analysis. For example, a few years ago I helped a reader deal with a problem involving a claim for approximately $1,200 for an outpatient procedure that had been performed at a local hospital. The insurance company provided less than $800 as reimbursement, leaving a balance bill of more than $400.
Although the doctor worked at the hospital, he also had two separate offices outside of the hospital. The address of each of those offices was printed on the bill that was submitted to the insurance company. The office in which the patient had originally been examined was near the hospital; the doctor's other office was farther away, in another town.
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