Wiki Estimating physician payment for unlisted procedure

[Mrsrpc]

We do a good job of finding comparator codes, but RVUs, as well as payment from commercial payers have to ge estimated. What happens if you overestimate in the eyes of the payer? Is there a penalty? Our estimates are data-based, but it’s not an exact science.

 

[thomas7331]

We do a good job of finding comparator codes, but RVUs, as well as payment from commercial payers have to ge estimated. What happens if you overestimate in the eyes of the payer? Is there a penalty? Our estimates are data-based, but it’s not an exact science.

There is no penalty. An estimate is just that - it's your practice's statement of what you think the procedure is worth. The payer is not required to accept that. If you have submitted the operative report, the payer has the opportunity to review it and counter with a different amount if they disagree with your estimate. As long as you have not misrepresented any information, then if they pay what you request you should not be subject to any kind of penalty.