5010 guarantor payments

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hrw911
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5010 guarantor payments

Post by hrw911 » Thu Oct 06, 2016 4:54 pm

Medicare requires that any guarantor payments be reported to them on the claim, but I don't see that Medisoft is sending that information. Am I just not looking the right place? They are stating that it should be in Loop 2300 2-1750-AMT02 (F5). I am using Medisoft Advanced version 19 sp. 1

hrw911
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Re: 5010 guarantor payments

Post by hrw911 » Thu Oct 06, 2016 5:03 pm

It looks like I can change that to show if I change the field in the Implementation Guide from Situational to Required, but I'm not sure if that's the best way to go about addressing this. Please let me know what you think.

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Gavin Walker
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Re: 5010 guarantor payments

Post by Gavin Walker » Fri Oct 07, 2016 6:23 pm

It looks like the iGuide is programmed to only send the amount patient paid if the provider is NOT Medicare participating and accept assignment is NOT checked on the case.
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hrw911
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Re: 5010 guarantor payments

Post by hrw911 » Mon Oct 10, 2016 7:54 am

According to Medicare instructions, that's an error.

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Gavin Walker
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Re: 5010 guarantor payments

Post by Gavin Walker » Mon Oct 10, 2016 11:57 am

I submitted a request to eMDs to have the iGuide changed.

hrw911
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Re: 5010 guarantor payments

Post by hrw911 » Mon Oct 10, 2016 12:54 pm

Thanks!

hrw911
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Re: 5010 guarantor payments

Post by hrw911 » Mon Oct 10, 2016 12:54 pm

Do you know how prompt they usually are about these kinds of updates?

hrw911
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Re: 5010 guarantor payments

Post by hrw911 » Mon Oct 10, 2016 2:20 pm

Also, do you know what the implementation guide says about sending this segment to payers other than Medicare? I'm trying to figure out if the fix is to send it all of the time, or only to send it to Medicare.

hrw911
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Re: 5010 guarantor payments

Post by hrw911 » Tue Oct 11, 2016 7:16 am

This was the "real world" advice I received when posting about this issue.:

Heather - I've never once seen that "rule" enforced. I do not know of any clients in the past 24 years that have shown on the claim how much the Medicare patient paid. Now, I do remember some clients did that back in 1992 and found that Medicare then split the claim and paid part of the claim to the patient and that caused all kinds of problems, so they learned to never put the amount on the claim the patient paid.

Years ago at another practice, we had a patient payment listed on a claim to Medicare & Medicare paid the patient instead of the practice.

Glad you said that Don. I was going to but thought..I am from the old
school and perhaps things have changed. I always have advised clients never
to put anything in that field.

It sounds like sending it will create a a lot of problems.

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Gavin Walker
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Re: 5010 guarantor payments

Post by Gavin Walker » Wed Oct 12, 2016 1:00 pm

Well, it has probably been programmed like this from the beginning and this is the first complaint I have heard about this.

hrw911
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Re: 5010 guarantor payments

Post by hrw911 » Wed Oct 12, 2016 1:37 pm

I only noticed it, because I sent in a paper claim that reported the patient payment amount, and it caused part of Medicare's check/payment to go to the patient, and when I researched why I found this requirement, and then started wondering why I hadn't encountered this situation more often.

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Gavin Walker
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Re: 5010 guarantor payments

Post by Gavin Walker » Wed Oct 12, 2016 6:52 pm

Well then, sending the claim electronically will probably also cause the payment to go the patient. You probably don't want to do that.

hrw911
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Re: 5010 guarantor payments

Post by hrw911 » Thu Oct 13, 2016 8:04 am

Agreed.

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