When not to show patient
paid amounts on claims form in Field 28
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 28 of the CMS-1500 (08/05) claim form. Here are a few notes
concerning this situation:
• When assignment is
accepted, Medicare Part B recommends:
• Since it is difficult to
predict when deductible/coinsurance amounts will be applicable - and
over-collection is considered program abuse - it is recommended that providers
do not collect these amounts 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 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 28 of form CMS-1500 (or electronic equivalent) when
assignment is not accepted.
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