Medical Billing Forum
Billing => Billing => : Healthy March 22, 2013, 05:36:53 PM
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Hi All
Any help will be greatly appreciated. I am new to billing, billing for a psychiatrist.my question is what is PR122 code in medicare EOB and what to do for that. Is it patient's responsibility that we should bill patient or secondary if any? Please advice.
Thanks
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Can any one please answer me.
Here is my question again
I am in CT, billing for mental health provider. I want to know what is PR 122 in medicare EOB and can we bill this to patient if he/she has no secondary insurance or it is a write off? Please help me for this.
I will appreciate your help.
Thanks
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PR 122 is the Remittance code for Psychiatric Reduction.
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Since you said you're new to billing and wanted help in deciphering what MC's RA is saying: The basics; the payment adjustments category descriptions are what you're seeing in front of the numbers, in this case it's PR w/MC = Patient Responsibility (it's usually for deductible and coinsurance). The 122 is a CARC code, and 122 means Psychiatric reduction and based on what I remember about MC they reduce payment when mental, etc services are furnished to individual not in an inpatient setting in a hospital (but double check this with them directly) or check your LCD (local determination coverage) for the CPT codes your billing. I do know the reductions are real and it happens when the primary DX code used is a mental health diagnosis, just don't remember if it matters about inpatient or outpatient. I also remember the reduction wasn't in every state.
So basically, PR122 = is MC saying: Patient Responsibility and there is a Psych reduction.
PR = Patient responsibility
CO = contractual obligation
CR = Correction and Reversal
OA = Other Adjustment
This is the link to MC's very large pdf on how to understand their remittance advice how to read the electronic and paper one's you can always search through the pdf for what you need whenver you have questions, but it's a good idea (since you're new) to read the whole thing. http://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&cad=rja&ved=0CC8QFjAA&url=http%3A%2F%2Fwww.cms.gov%2FOutreach-and-Education%2FMedicare-Learning-Network-MLN%2FMLNProducts%2Fdownloads%2Fra_guide_full_03-22-06.pdf&ei=JjBSUen5MsjA4APS-ICQBA&usg=AFQjCNGqH8PA-TslRclZd1zXPtmlRq_oXw&bvm=bv.44342787,d.dmg (http://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&cad=rja&ved=0CC8QFjAA&url=http%3A%2F%2Fwww.cms.gov%2FOutreach-and-Education%2FMedicare-Learning-Network-MLN%2FMLNProducts%2Fdownloads%2Fra_guide_full_03-22-06.pdf&ei=JjBSUen5MsjA4APS-ICQBA&usg=AFQjCNGqH8PA-TslRclZd1zXPtmlRq_oXw&bvm=bv.44342787,d.dmg)
Use this link, which MC provides a link to for CARC codes (those numbers you're seeing)http://www.wpc-edi.com/reference/codelists/healthcare/claim-adjustment-reason-codes/ (http://www.wpc-edi.com/reference/codelists/healthcare/claim-adjustment-reason-codes/) and this is the main site which lists more links to codes RARC, etc http://www.wpc-edi.com/reference/ (http://www.wpc-edi.com/reference/)
For Medicare LCD's visit this link ---> http://www.cms.gov/medicare-coverage-database/ (http://www.cms.gov/medicare-coverage-database/)
Oh, wanted to add it sounds like your patient is responsible for something (what is something you'll have to determine), and if they have no secondary ins, then you can bill them, but be sure you know exactly how much and why before doing so. Again, this is all on the RA you have, just learn how to read it. Hope this helps.
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Thank you so much PMRC and billergirlnyc . I will definitely check web site for MC.
Thanks again.
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Healthy - here is a more accessible list of codes you are likely to find on the Medicare EOB's. You may find a similar list in the links that Billergirlnyc gave you, but the codes at this link are on the first page that comes up. You don't have to search for them.
http://www.webanswers.com/health/medicare-medicaid/medicare-remittance-codes-category-38f053
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That is a better list format but it's outdated :( I have hard copy I keep for reference and update myself, there's quite a few missing. You can actually get a list from your Medicare carrier as well and some of them will publish updated articles on remittance code updates from time to time. Especially when they make a boo boo <g>
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Exactly, Linda, thus why I didn't share that link. The link I provided comes directly from CMS's pdf's and they keep it updated. While it's exhaustive, searching is as simple as scrolling down for the number you're seeking, etc.
To Healthy, glad we could help, and don't be afraid to ask us anything else, eventually someone will respond (if they can).
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In PDF you can also look up certain things with the lookup tool ;)
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Of course, but I was speaking to the actual link to the codes in terms of searching, not the pdf. Searching within a pdf is my daily goto tool :)
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it's outdated :(
My bad. That's what I get for being too much in a hurry.:-\ I didn't examine the list or the posting date. I was mostly trying to make the point for the new biller that one can type CPT and/or DX Codes into Google and get discussions about them that can be useful. But, yeah. If you do this, make sure you look at the date the information was posted to make sure you are looking at current information.
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no, your not bad.. I was making point that this is probably one of those things you should get and keep updated yourself, I would imagine it would be too hard to keep that list so updated. Not as simple as the POS or TOS codes <g> I'm still very anal .. I have cheat sheets everywhere, I have binders with easy reference tabs.. I love my paper :)
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I have cheat sheets everywhere, I have binders with easy reference tabs.. I love my paper :)
Yes.
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Thanks all! I am so happy that every one out there willing to help me. God bless you all.
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