Good Afternoon- We are a CAH method 1 w/ passthrough payments for Anesthesia and we bill Anesthesia on a UB for medicare. We have a CRNA that comes and does our epidurals and my question is what provider do i enter in Form locator 77 on the UB? Do I enter the Ordering Physician or do I enter the CRNA?
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Most of the practices would collect copayments from the patient at the time service. Although it’s not a violation for participating providers to accept payment prior to rendering services, there are specific guidelines to follow, especially when reporting these payments.
Additionally, some providers who accept assignment have a concern that Medicare issues partial checks to beneficiaries. Such checks are generally issued because of a patient paid amount in item 29 of the CMS-1500 (02/12) claim form.
Here are a few guidelines to follow;
Medicare Part B recommends not to collect copay amounts prior to a claim being submitted to Medicare since it is difficult to predict when deductible/coinsurance amounts will be applicable (and over-collection is considered program abuse). So, it is recommended that providers not to do so until Medicare Part B payment is received.
If you believe you can accurately predict the coinsurance amount and wish to collect it before Medicare Part B payment is received, note the amount collected for coinsurance on your claim form. It is recommended that providers do not collect the deductible prior to receiving payment from Medicare Part B because, as noted above, over-collection is considered program abuse. In addition, this practice can cause a portion of the provider’s check to be issued to beneficiaries on assigned claims.
Do not collect money from the patient for the preventive services for which copayment and coinsurance are waived. Please refer Preventive Services covered by Medicare.
Do not show any amounts collected from patients if the service is never covered by Medicare Part B or you believe, in a particular case, the service will be denied payment. Where patient paid amounts are shown for services that are denied payment, a portion of the provider’s check may go to the beneficiary.
There is no need to show a patient paid amount in item 29 of form CMS-1500 (or electronic equivalent) when assignment is not accepted.
Reference: https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c26.pdf
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Code for the Day: Let’s Hope Steamboat Springs’ Lighted Man Never Sees This on a Claim Form
I just spent a very fun weekend in Steamboat Springs with my boyfriend visiting his family. For the second year in a row, we decided that the prime weekend for a visit was during Winter Carnival, which is pretty spectacular if you ever have the chance to witness it. During the day, they load up Main Street with snow for events such as the donkey jump, where local cowboys saddle up their horses so they can drag kids on skis over ski jumps (something my boyfriend has experienced and survived) or the shovel race, where the cowboys drag “grown” men sitting on snow shovels down the street to see who can get the best time.
There are lots of other things going on as well. Last year, we went to Howelsen Hill – home of the Steamboat Springs Winter Sports Club and training ground of many Olympians – to watch some ski jumps. But perhaps the biggest draw is Saturday night’s fireworks display and the Lighted Man. This show begins after dark at Howelsen Hill as skiers carrying flares make their way down the mountain. Cut your eyes to the right, and you will see ski jumpers with flares jumping through a ring of fire. But the grand finale is always the Lighted Man – a skier outfitted in a suit of LED lights making his way down the hill while fireworks shooting from his body.
As for me, since I don’t downhill ski, I spent the weekend running barefoot through snow-lined walkways from pool to pool at the hot springs, traipsing through a man-made ice castle, and giving cross country skiing a try. There were so many options for a code for the day, but I kept coming back to the Lighted Man. Because codes on a claim tell a story, I just wonder what the insurance company would say should the Lighted Man have to report these codes:
- W39.xxxA, Discharge of firework, Initial encounter
- Y93.23, Activity, snow (alpine) (downhill) skiing, snow boarding, sledding, tobogganing and snow tubing
It’s such a fun tradition, I hope he never has to find out. I didn’t get close enough to the mountain this year to get a good pic of the Lighted Man, but if you’d like to see some great pictures of the Winter Carnival is like, there is a good synopsis if you click here.
Coder Coach
Showing Patient Payments in CMS 1500 form
Most of the practices would collect copayments from the patient at the time service. Although it’s not a violation for participating providers to accept payment prior to rendering services, there are specific guidelines to follow, especially when reporting these payments.
Additionally, some providers who accept assignment have a concern that Medicare issues partial checks to beneficiaries. Such checks are generally issued because of a patient paid amount in item 29 of the CMS-1500 (02/12) claim form.
Here are a few guidelines to follow;
Medicare Part B recommends not to collect copay amounts prior to a claim being submitted to Medicare since it is difficult to predict when deductible/coinsurance amounts will be applicable (and over-collection is considered program abuse). So, it is recommended that providers not to do so until Medicare Part B payment is received.
If you believe you can accurately predict the coinsurance amount and wish to collect it before Medicare Part B payment is received, note the amount collected for coinsurance on your claim form. It is recommended that providers do not collect the deductible prior to receiving payment from Medicare Part B because, as noted above, over-collection is considered program abuse. In addition, this practice can cause a portion of the provider’s check to be issued to beneficiaries on assigned claims.
Do not collect money from the patient for the preventive services for which copayment and coinsurance are waived. Please refer Preventive Services covered by Medicare.
Do not show any amounts collected from patients if the service is never covered by Medicare Part B or you believe, in a particular case, the service will be denied payment. Where patient paid amounts are shown for services that are denied payment, a portion of the provider’s check may go to the beneficiary.
There is no need to show a patient paid amount in item 29 of form CMS-1500 (or electronic equivalent) when assignment is not accepted.
Reference: https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c26.pdf