canbrody
New
We have come across several ERAs from Medicare and the totals do not all add up from a posting perspective. Any ideas?
For example, allowed amount is $102.44 (this counts the 2% PQRS reduction for the actual fee schedule of $104.53).
The coinsurance = 20% of $102.44 for $20.49
CO-237 is noted as $3.73
CO-253 is noted as $1.61
Payment is $78.70
In doing the math backwards, I found that Medicare is taking 80% of the allowed amount ($81.95) then subtracting the CO 237 different between the fee schedule, billed amount, and CO 237 amount as noted (104.53-102.44-3.73 = $1.64) then doing the 98% federal sequester to get payment.
$81.95-1.64 = $80.31 x 98% = $78.70.
The problem is I cannot find out what the additional reduction is for from all of the CMS PQRS sites. Plus, I have another administrator who is taking a much larger reduction on the initial allowed amount, but the end math appears to be the same.
I am going nuts, any ideas? Auto posting is certainly not balancing on these.
We have administrators all over the country, NOridian, CGS, NGS, Novitas, Palmetto, just to name a few.
For example, allowed amount is $102.44 (this counts the 2% PQRS reduction for the actual fee schedule of $104.53).
The coinsurance = 20% of $102.44 for $20.49
CO-237 is noted as $3.73
CO-253 is noted as $1.61
Payment is $78.70
In doing the math backwards, I found that Medicare is taking 80% of the allowed amount ($81.95) then subtracting the CO 237 different between the fee schedule, billed amount, and CO 237 amount as noted (104.53-102.44-3.73 = $1.64) then doing the 98% federal sequester to get payment.
$81.95-1.64 = $80.31 x 98% = $78.70.
The problem is I cannot find out what the additional reduction is for from all of the CMS PQRS sites. Plus, I have another administrator who is taking a much larger reduction on the initial allowed amount, but the end math appears to be the same.
I am going nuts, any ideas? Auto posting is certainly not balancing on these.
We have administrators all over the country, NOridian, CGS, NGS, Novitas, Palmetto, just to name a few.