Question:

In the inpatient and outpatient charge data, what is the difference between “average charges” and “average total payments”?

Answer:

“Average charges” refers to what the provider bills to Medicare. “Average total payments” refers to what Medicare actually pays to the provider as well as co-payment and deductible amounts that the beneficiary is responsible for and payments by third parties for coordination of benefits.

 

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Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.

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