The question of whether a provider’s charges are reasonable arises when there is no provider contract or government regulation setting the rate for a service (e.g., out-of-network providers in health plans, personal injury cases, first-person auto claims), and when the third-party payor sets the allowed amount based on the Usual, Customary, and Reasonable (“UCR”) charge method. RPC regularly updates its UCR calculations to reflect newer data, improved methods, and more research. The white paper discusses differences in our UCR values from other published UCR values.
This version of the white paper discusses sources and methods for RPC’s Usual, Customary, and Reasonable Charge Database for Practitioner Charges as of October 2020. Read the full paper here.