jentjohnson
New
The insurance has a limited benefit for office visits. The insurance says the patient responsibility is still $50 copay but they are not paying the rest of the allowable. Does the patient get changed the remaining allowable?
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Wiki Ineligibly on EOB
- Thread starter jentjohnson
- Start date
trarut
True Blue
Are there are denial or remark codes on the remit that indicate the balance is patient responsibility? I would not guess - I would call the insurance and request clarification and a correct remit if appropriate.
jentjohnson
New
No denial code but it does still look like patient responsibility. Worse case scenario, offer self pay after limitation reached?
SharonCollachi
Guest
Still looks like PR to me.
trarut
True Blue
Agree with Sharon. These are patient responsibility without a doubt. Look at the Member Liability fields - the Total of each line is the sum of the ineligible amount + the copay due. The total member liability is also equal to the Allowed Charges listed. And last, but not least, the Pay To code is PR (Patient Responsibility).
jentjohnson
New
Thank you all. I just needed to see these responses from other certified coders as my higher is not certified. One last question: I'm just entering under ded, copay, coins, whichever our policy wishes to call it? I've never seen a policy for billing/coding...
SharonCollachi
Guest
Yes, just be consistent with what you call it. I would probably call it "coinsurance", as I've had people argue with me that it's not a copay. I can attach a code in my system when I'm posting the payment, and I would attach one that says "Maximum benefit reached."
jentjohnson
New
I'm so glad I decided to ask my questions here. I usually forget the forums exist. Thank you, Sharon.