This is the type of discussion I would like to get started in order to find
out whether provider refunds are considered in or out of scope for the 835.
Thanks!
Jonathan Showalter
Omaha NE USA
402-343-3381
[EMAIL PROTECTED]
------------------( Forwarded letter 1 follows )---------------------
Date: Thu, 11 Oct 2001 09:56:09 -0400
To: JONATHAN.SHOWALTER, Julie.Thompson[julie_a_thompson]@hotmail.com,
[EMAIL PROTECTED], [EMAIL PROTECTED]
From: Marguerite.A.DeForge[DeforgeMA]@aetna.com
Subject: RE: Refunds
Maybe there is a need to be careful not to mix remittance and refunds.
These two accounting procedures could very well not be driven by the same
source - the bill. The 835 should reflect what was remitted on a bill (837)
and not necessarily what was refunded.
Peg DeForge
636-2141, MA3H
-----Original Message-----
From: Julie Thompson [mailto:[EMAIL PROTECTED]]
Sent: Thursday, October 11, 2001 9:51 AM
To: [EMAIL PROTECTED]; [EMAIL PROTECTED];
[EMAIL PROTECTED]
Subject: Re: Refunds
Good questions, Jonathan!
Since no one has answered, I thought I would give it a shot.
I will assume you are referring to "Patient Refunds".
Under New York and New Jersey state legislation, there is a requirement to
notify both patient and provider regarding all payments.
It is safe to say, this would include notification to all parties for
payment adjustment and corrections.
Other states may not have this requirement.
HIPAA requires payment notification to the provider, even when the payment
to the provider is 0.00 (captitated services), or when any adjustments or
corrections are made.
Also, there is a summary amount for patient payments. The description on
page 250 of the 835 Guide Data dictionary for Total Patient Reimbursement
Amount, Loop 2000, Segement TS322 describes the element as the total of all
patient refund amounts. The element that would be sued to accumulate this
amount should be Loop 2100, AMT02.
Technically, this should work properly. The guide could use some greater
clarity on this process.
Julie A. Thompson
the remittance itself
From: [EMAIL PROTECTED]
To: [EMAIL PROTECTED], [EMAIL PROTECTED]
Subject: Refunds
Date: Tue, 9 Oct 2001 10:20:00 -0500
I posted this question last week but did not get any response. I thought I
would try one more time.
I wanted to ask the group if any of you are thinking about how you will
handle
refunds and whether or not refunds should produce a correction and reversal
835. The 835 might be sent to reflect the refund once it has been received
by
the payor or as a device to notify the provider that a refund should be
made,
etc.... or do you think refunds fall outside of the 835 process?
Thanks!
Jonathan Showalter
Omaha NE USA
402-343-3381
[EMAIL PROTECTED]
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