DME MACs Clarify "Amount Paid" on Assigned Medicare Claims

The Medicare DME MACs have issued a clarification on the submission of the "amount paid" on assigned claims.

The clarification applies only to assigned claims, and specifically refers to Item 29 on the CMS-1500 claim form or its electronic equivalent, according to a March bulletin distributed by NHIC Corp., the Jurisdiction A DME MAC.

"Suppliers are reminded that Item 29 of the CMS-1500 Claim Form or the electronic equivalent is to be completed with the 'total amount the patient paid on the covered services only,'" the bulletin said. "Any beneficiary payment amount collected for the specific covered items submitted on the claim (i.e., co-insurance and deductible) should be reflected with the claim submission."

The bulletin added, "Suppliers should not report any money collected on noncovered items, upgraded items or items expected to be denied as not reasonable and necessary with an ABN (Advance Beneficiary Notice of Noncoverage) on file. In the event Medicare is the secondary payor, suppliers should not report any primary insurance payments in the 'Amount Paid' field."

The bulletin also reminded suppliers that deductibles are applied "based on the first claim to complete processing and not necessarily the claim with the earliest date of service in the year.... Therefore, suppliers are strongly encouraged to wait and collect the deductible after a claim has been finalized and included on the remittance advice."

About the Author

Laurie Watanabe is the editor of Mobility Management. She can be reached at lwatanabe@1105media.com.

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