Rounding of Reasonable Charge Calculation

80.4.1 - Rounding of Reasonable Charge Calculation (Rev. 1, 10-01-03) B3-5021 A/B MAC (B) screens should include both dollars and cents. Rounding of customary and prevailing charges should not normally take place with one exception. Rounding is permitted in situations where the A/B MAC (B)’s customary charge calculation is clearly erroneous and results in a peculiar or odd cent amount, e.g., $8.33. In such an instance, rounding to the nearest l0 cents is permissible, pending the required correction of the calculation, where the data result in a customary charge that is not in 25- cent or 75-cent units. For other than the 25-cent or 75-cent amounts, fractional amounts ending in 5-cent increments should be rounded up to the nearest l0 cents. However, where the A/B MAC (B) knows the odd cents in a customary charge calculation are correct, e.g., because a sales tax is involved in the charges made by a physician, then no rounding of the odd cents should take place. The above exception applies only to customary charge calculations, and not to prevailing charges. The exception is permissible only as an interim measure to deal with an immediate problem. The A/B MAC (B) should promptly identify the cause of the error and take appropriate corrective action. There should be no need for rounding initial prevailing charge calculations since actual customary charges are used to establish these screens.