What basis may a payer use to create a fee schedule for practitioners?

A payer may create a fee schedule for practitioners based on a percentage of industry-accepted fee schedules because this approach helps establish a benchmark that reflects the standard rates for healthcare services within a specific geographical area or specialty. By referring to these established fee schedules, payers can ensure that their reimbursement rates are competitive and fair compared to what other entities are paying for similar services. This method allows for consistency in payments, aids in budgeting for both the payer and the providers, and encourages adherence to best practices within the industry.

The use of a percentage of industry-accepted fee schedules is grounded in the desire to balance cost control with adequate compensation for healthcare services. This promotes a transparent and measurable standard for reimbursement, which is essential for both payers and practitioners in managing their financial relationships effectively.