Wednesday 31 October 2012

Medicare EOB - Detailed Review 1


Detail Fields:

Serv Date: This field provides the service from and to dates as well as the patient's responsibility.

POS: The place of service field contains a two digit number that references where the services were rendered.

NOS: The number of service field shows how many services were billed per procedure code.

Proc: The procedure code is located in this column as well as the patients Health Insurance Claim number (HIC) or the Medicare number.


MODS: If any modifi
ers were billed, they will be located in this field.

Medicare EOB - Detailed Review


Claim Total Fields:
Billed: This field also contains the billed amount per procedure. If the patient account number is reported on the claim, Medicare will display that number in this field.

Allowed: This column displays the allowed amounts per procedure. This amount is based on the Medicare Fee Schedule.

Deduct: If any deductible is applied the amount will show in this field. The Internal Control Number (ICN) will also appear in this column.

Coins: This is the coinsurance field. The amount of the beneficiary's coinsurance, 20% of the allowed amount, will be displayed here.

Group Reason Code (GRP/RC): Group codes represent the financially responsible party. Reason codes explain denials and payments. These combinations of codes are defined in the glossary at the bottom of the Standard Provider Remittance.

Grp/RC-Amt: This column contains the type of assignment (ASG). A "Y" indicator shows the provider accepted assignment. A "N" indicator shows a non-assigned claim. Under the assignment indicator are the non-covered service amounts. These amounts will equal the difference between the billed amount and allowed amount. The last field in this column is a total of the non-covered amounts.

Prov. Pd: The amount paid per procedure is displayed in this field. Also the total amount paid on this claim is shown in this column. The claim total reported is the net payment. The MOA (Medicare outpatient adjudication remarks) code is the heading. This code does not display any adjustments or reasons. The codes following this heading explain the outcome of the claim, and also need to be defined in the glossary.

Adj. To Totals: Adjustments are printed on the ADJs line.

Prev Pd: For full claim adjustments, the Prev Pd field represents the previous accumulative payment to the provider, on an original claim, and has the GRP/RC-AMT value OA-B13

INT: This field represents the difference between the current interest on the adjustment claim and the previous interest from the original claim.

Late Filing Charge: This field represents the reduction taken when the claim was submitted more than 1 year after the date of service.

Claim Information Forwarded To: This represents the patient's secondary insurance carrier.

Net: This field represents the net amount for a given claim, which should be the actual amount being paid for that claim to the provider. This field does include interest.
Summary (Totals) fields:
#
 Of Claims: Number of claims displayed on the SPR.

Billed Amt: Total amount billed on the SPR.

Allowed Amt: Total allowed amount on the SPR. This amount is based on Medicare’s Fee Schedule.

Deduct Amt: The total amount of the deductible applied on the SPR.

Coins Amt: Total amount of coinsurance on the SPR.

Total RC-Amt: Total amount of non-covered services. This is the difference between the total billed amount and the total allowed amount.

Prov. Pd Amt: The total amount paid on the SPR. This should be the check amount if no adjustments were made.

ADJS Fields:Prov Adj. Amt: The amount the check has been adjusted from the provider's aid amount.

Check Amt: The amount of the check.


Offset Fields Offsets to payments are shown as an adjustment from the provider's payment at the summary level rather than as an adjustment against an individual claim in that remittance notice.

Offset Details: This field displays the reason for the offset. A two letter code is shown. The codes need to be defined in the glossary. AP = Advanced Payment.FB = Balance Forward. This can represent an amount under $1.00 which will be paid in the future. L6 = Interest applied. The difference between the original interest amount and the adjusted interested amount. 50 = Late filing reduction WO = Withholding Offset as a result of a previous payment CS = Adjustment - The amount paid on an original claim for full adjustments. B2 = Refund

FCN: The financial control numbers that associate the offset with those claims and payments that led to the withholding. FCN information is not applicable for IN and LF.
HIC: The field displays the health insurance claim number of the patient who caused the offset. Multiple HIC numbers will not be printed. HIC information is not applicable for IN and LF.

Amount: The amount being withheld or added

Glossary: This is a guide to all the reason codes. Use remarks and codes in the claim detail and summary portions of SPR to determine the outcome of the claim.For complete details regarding the new Standard Paper Remittance, please check your MCS Transition News.

8 comments:

  1. Great Reviews !
    Actually i have filed a financial claim but failed to get any help from my insurance company . You review has provided me the various things you must consider to make a successful claims .

    Thanks
    William Martin

    Financial Claims Made Simple

    ReplyDelete
    Replies
    1. Just read your post and would like to thank you for maintaining such a cool blog.
      Custom Orthotics Brampton

      Delete
  2. This comment has been removed by the author.

    ReplyDelete
  3. One insurance employee for every two doctors in the US is a huge overhead to support, costing $500 per person annually. Actually, I agree with some of the points you raised.
    claims pages

    ReplyDelete
  4. Many thanks for the exciting blog posting! I really enjoyed reading it, you are a brilliant writer. I actually added your blog to my favorites and will look forward for more updates. Great Job, Keep it up..
    chiropractic EHR software 

    ReplyDelete
  5. Thanks For sharing!!!

    Medical Transcription Services USA - Pert offers Medical Transcription Services and Solutions in USA, India. EMR transcription, EHR transcription services at low rates. Call now: +1-704-241-3252



    14. Medical Transcription Service Provider 15. Medical Transcription Billing Corp 16. Medical Transcription Services Canada 17. Emr Transcription Services India 18. Medical Transcription Companies In Delhi 19. Transcription Services India 20. Transcription Services Delhi 21. Healthcare Transcription Services India 22. Revenue Cycle Management India 23. Revenue Cycle Management Canada 24. Revenue Cycle Management Services India 25. Revenue Cycle Management & Coding Services 26. Canada Back-Office Operations 27. Chiropractic Billing India 28. Chiropractor Billing And Coding India 29. Chiropractor Billing And Coding Canada 30. Outsource Medical Transcription 31. Outsource Medical Billing And Coding Services 32. Medical Billing & Coding Solutions 33. Medical Billing 34. Medical Coding 35. Outsource Medical Transcription Services 36. Outsource Medical Transcription 37. Outsource Medical Transcription Services 38. medical transcription outsourcing companies in india 39. Outsourcing Medical Coding to India 40. Outsource Transcription Services India 41. Companies Outsourcing Medical Transcription Work To India 42. Offshoring of healthcare services 43. Medical Transcription Services Delhi 44. Why outsource medical transcription to India? 44. Outsource Medical Billing & Coding Services 45. Outsource Voice Transcription

    ReplyDelete
  6. This blog is very informative. Packing can be a long hectic process but it can be made easier by following the tips that you have mentioned above. Thanks for sharing such important and useful information. Keep it up.
    visit mentioned website for printing services.
    Outsourcing Medical Billing Services in Dallas

    ReplyDelete

Popular Posts