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Thread: Billing question

  1. #1

    Default Billing question

    AAPC: Back to School
    Hello all. I know this is a coding website and forum but I also know that a lot of us wear multiple hats so I was hoping someone could help me with a billing question.

    I work at an ASC and we verify insurance and collect estimated patient responsibility at the time of check-in. Our verification staff is awesome and more than 9 times out of 10 the amount is exactly right.

    We received a bad letter from a patient (who is a retired doctor) and he was not happy with his visit. The medical care was fine but he was upset that he had to wait and didn't get the uninterupted attention that he desired. This lead to a letter detailing everything he could think of that he felt was wrong with his service. One of the items listed was that the amount that he paid to us at the time of check in was not reported to Medicare on the claim form.

    We have never reported this on our claim form. It is electronic but even when we were paper, we didn't. We are not collecting more than Medicare states the patient should pay anyway once the claim is processed. I have been in the medical field for over 20 years and have never included this information on my claim form. I called Medicare and I don't think I got someone that was knowledgable. I spoke with other professionals in our area and they all said the same thing I did.

    The Medicare rep did say that it would affect our reimbursement in the fact that what Medicare pays us would be reduced by the reported amount the patient paid. (Not sure I understand that).

    Does anyone have information for me regarding this issue? My next step is to correspond with the Medical Director of Medicare for our region but just wanted other imput.

    Thank you.

  2. #2
    Join Date
    Apr 2007
    Columbia, MO


    are you filing UB04 claim forms or 1500?

    Debra A. Mitchell, MSPH, CPC-H

  3. #3


    1500 electronically

  4. #4
    Join Date
    Apr 2007
    Columbia, MO


    On the 1590 the total amount of the claim as well as the balance due are required fields. The balance due is the amount after the patient payment. The amount collected field is not required, but by filling in the balance due amount you are reporting the amount paid. If this is not a field you fill in on your system then your sofware is probably auto populating the claim total and the balance due amount to be the same amount. Which is incorrect in the scenario you have described.

    Debra A. Mitchell, MSPH, CPC-H

  5. #5


    Debra, Thanks for the information you gave. I really appreciate it. I noticed you're in MO, do you have the same contractor for Medicare that we have in Arizona? We have Noridian.

    Just curious.

    Thanks again

  6. #6
    Join Date
    Apr 2007
    Columbia, MO


    I do not think so but most of my work is done in other states. I have clients in California, New York, Alabama, Iowa, Colorado and Arizona.

    Debra A. Mitchell, MSPH, CPC-H

  7. #7

    Default Tikosyn Therapy

    Does anyone know if their is a CPT for the Tikosyn Therapy or HCPC code only for this?

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