MEDICARE TIPS

Wait for the 14 day electronic and 29 day paper payment floor before calling-use the IVR system

Remittance Advice

Group Code meanings to assist providers in reading remittance advices

Payment Calculation

Medicare payment at 80% of the allowable, minus deductibles for a participating provider. Example: Charge $120
Allowed $100
Medicare Paid (80%) $80
Deductible/coinsurance amounts $20 (20%)

PR Patient Responsibility

This signifies the amount that may be billed to the beneficiary or to another payer on the beneficiary's behalf. The PR codes are used with the reason codes.
· Patient deductible or coinsurance

MEDICARE TIPS

Wait for the 14 day electronic and 29 day paper payment floor before calling-use the IVR system

Remittance Advice

Group Code meanings to assist providers in reading remittance advices

Payment Calculation

Medicare payment at 80% of the allowable, minus deductibles for a participating provider. Example: Charge $120
Allowed $100
Medicare Paid (80%) $80
Deductible/coinsurance amounts $20 (20%)

PR Patient Responsibility

This signifies the amount that may be billed to the beneficiary or to another payer on the beneficiary's behalf. The PR codes are used with the reason codes.
· Patient deductible or coinsurance
· Patient assumed financial responsibility for a service not considered reasonable
· Cost of therapy or psychiatric services after the coverage limit has been reached
· Charge denied because of the patient's failure to supply primary payer or other information
· Patient is responsible for payment of excess non-assigned physician charges