Billing > Billing

PR122

(1/6) > >>

Healthy:
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

Healthy:
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

PMRNC:
PR 122 is the Remittance code for Psychiatric Reduction.

Billergirlnyc:
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

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/ and this is the main site which lists more links to codes RARC, etc http://www.wpc-edi.com/reference/

For Medicare LCD's visit this link ---> 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.

Healthy:
Thank you so much PMRC and billergirlnyc . I will definitely check web site for MC.
Thanks again.

Navigation

[0] Message Index

[#] Next page