CCO Admin asked:
Newbie with Question regarding zero pay Medicare ERAs: If Medicare sends an ERA that says 1) PR 1 - payment was put to deductible; or 2) OA 100 - Payment made to patient/insured/responsible party; should that be posted or adjusted manually somehow? It appears that when we post in our EMR; the adjustment from the zero pay claims shows as a CREDIT/REFUND to the patient; which obviously creates problems. The EMR company is aware of the problem but has not fixed it as yet; and they have no medical billers on staff to help me know what to do. Any help anyone can give would be greatly appreciated.
Answer:
Misty Haralson wrote: were there other claim lines billed? and was money put on that claim from the patient when the claim was sent out to medicare. usually medicare will pay the patient if medicare sees that money was already applied to the claim when it was billed to them. like copays or deductibles.
Newbie with Question regarding zero pay Medicare ERAs: If Medicare sends an ERA that says 1) PR 1 - payment was put to deductible; or 2) OA 100 - Payment made to patient/insured/responsible party; should that be posted or adjusted manually somehow? It appears that when we post in our EMR; the adjustment from the zero pay claims shows as a CREDIT/REFUND to the patient; which obviously creates problems. The EMR company is aware of the problem but has not fixed it as yet; and they have no medical billers on staff to help me know what to do. Any help anyone can give would be greatly appreciated.
Answer:
Misty Haralson wrote: were there other claim lines billed? and was money put on that claim from the patient when the claim was sent out to medicare. usually medicare will pay the patient if medicare sees that money was already applied to the claim when it was billed to them. like copays or deductibles.
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