Principles for Sharing Costs of Physician Profiles When Used for

470.2 - Principles for Sharing Costs of Physician Profiles When Used for Medicare and the Carriers' Regular Business - (Rev. 1, 08-30-02) B1-4603.2 Criteria for the determination of reasonable charges for the Part B program required carriers to secure and maintain data. These criteria also emphasize that data supporting the customary charge of the physician are to be obtained from all sources available to the carrier so that the customary charge will reflect the charge made generally to the physician's patients for a particular service. Where several programs or lines of business derive mutual benefits from the use of physician profile data, the following principle should be observed to assure equitable distribution of costs: Where physician profiles established on data derived in whole or in part from the Medicare program are used by a carrier in any other program or business, cost sharing is required. The cost chargeable to the Medicare program will be determined by the volume of Medicare claims processed to the total claims processed for all lines of business using the physician profile data. The Secretary and the Secretary's delegated subordinates have a contractual right to information necessary to insure program continuity and to insure maximum efficiency and effectiveness. If a change of carriers in an area were to occur, it might be necessary to transfer to the succeeding carrier appropriate data to assure that no disruption of reasonable charge determinations would result. Such data would be protected from unwarranted disclosure under Administration regulations on confidentiality.