Witholds and secondary claims

Technical problems with Medisoft.
hrw911
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Witholds and secondary claims

Post by hrw911 » Tue Aug 26, 2014 9:16 am

I am having the following issue. If I post a withold by the primary insurance, that amount is not showing up on the electronic secondary claim, so my claim gets rejected because it doesn't balance (all payments, adjustments, etc. do not add up to the charge amount).

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Gavin Walker
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Re: Witholds and secondary claims

Post by Gavin Walker » Tue Aug 26, 2014 10:26 am

Do you submit claims and post remittances with Revenue Management?
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hrw911
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Re: Witholds and secondary claims

Post by hrw911 » Tue Aug 26, 2014 4:44 pm

I do submit all of my electronic claims with RM. I only post some remits with it. Many have to be manually posted.

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Gavin Walker
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Re: Witholds and secondary claims

Post by Gavin Walker » Wed Aug 27, 2014 9:40 am

All line items on the claim must be paid by the primary payer - even if it is a $0 pay. The line items on the secondary claim must match what was sent on the primary claim.

hrw911
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Re: Witholds and secondary claims

Post by hrw911 » Sun Dec 07, 2014 4:18 pm

They are being paid by the primary payer, but Medisoft is not accounting for any amount applied as a withold by the primary payer. For example:

The charge for a line is $10. The primary carrier allows $8 (so there's an adjustment of $2) pays $5 and withholds $2. The patient's balance is $1.

Medisoft only shows the payment, and the adjustment. It does not show the withold, so my claim is rejected by thesecondary carrier because it's out of balace by $2.

hrw911
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Re: Witholds and secondary claims

Post by hrw911 » Thu Jun 30, 2016 8:59 am

I am still having this problem. Do you know of any solution to it?

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Gavin Walker
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Re: Witholds and secondary claims

Post by Gavin Walker » Thu Jun 30, 2016 1:49 pm

That sounds correct. By withholding $2 that means the insurance intends to pay that $2 probably at the end of the year and the patient owes $1.
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hrw911
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Re: Witholds and secondary claims

Post by hrw911 » Thu Jun 30, 2016 1:55 pm

I am posting (as are most of the billers that I've consulted) the Medicare sequestration 2% reduction as a withhold. This 2% amount does not show up as an adjustment when I submit the secondary claim, which causes my claims to rejected since they don't "balance".

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Gavin Walker
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Re: Witholds and secondary claims

Post by Gavin Walker » Thu Jun 30, 2016 4:40 pm

Yeah, I think it should be setup as an Insurance Adjustment because Medicare is expecting the doctor to take the hit on this one. Interestingly, if the doctor does not participate with Medicare, then the patient takes the 2% hit.

dkennelly
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Re: Witholds and secondary claims

Post by dkennelly » Wed Jan 13, 2021 1:33 pm

I know this is an old post, but I just started submitting secondary claims. When I submit with the MIPS reduction (similar to the sequestration), it doesn't show up on the clearinghouse end. The CO-45 shows up with the correct amount, but the CO-237 does not show up and I have to put it in manually on the clearinghouse website. Is there a way to set up revenue management to pick this up? I submit all my claims through revenue management, but post remits manually in medisoft.
Thanks in advance!

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Gavin Walker
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Re: Witholds and secondary claims

Post by Gavin Walker » Thu Jan 14, 2021 4:06 pm

Hi, you can just post these as an Insurance Adjustment. The doctor is being penalized for not participating with an electronic health record for MIPS/MACRA.

dkennelly
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Re: Witholds and secondary claims

Post by dkennelly » Thu Jan 14, 2021 4:54 pm

That's what I'm doing, but the clearinghouse (emdeon) is only picking up the first insurance adjustment and labeling it CO-45, which is the regular reduction, it's not picking up the additional adjustment, which should be CO-237 for the MIPS adjustment. Is there another way to classify it so that it gets picked up also. I do enter the payments manually, so, it doesn't come through on an ERA or anything.
Thanks

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Gavin Walker
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Re: Witholds and secondary claims

Post by Gavin Walker » Mon Jan 18, 2021 11:16 am

The clearinghouse should be sending both adjustments in the EOB, but you may have to setup CO-237 as an adjustment code in Revenue Management or it won't post it for you.

hrw911
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Re: Witholds and secondary claims

Post by hrw911 » Mon Jan 18, 2021 11:54 am

No withhold codes/amounts are sent on the secondary claim even if it's posted correctly by RM or manually. I use Office Ally and have to go in and manually add those adjustments after the claim rejects for not balancing.

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Gavin Walker
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Re: Witholds and secondary claims

Post by Gavin Walker » Tue Jan 19, 2021 9:28 am

There is the option in Revenue Management to post adjustments from secondary payers. It doesn't happen very often, so I normally leave that option turned off.

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