Wiki Medicare non-payment on remittance advice

[FABBOTT]

Hello,

I bill for a psychiatry office in Florida. Currently, on our remittance advices, we have had a lot of non-payments (they are indicated as paid to the patient on the RA). The CARC and RARC codes don't seem to give any reasons. My best assumption is that these are take backs for cost-sharing for patients that are dually qualified for both Medicare and Medicaid. We currently use a horrible billing system (Medisoft) and I've only recently taken over the billing. I've called Medicare and have gotten nowhere. Any advice or input is greatly appreciated!!

Thank you.

 

[orthobiller2017]

RA

Does the remittance advice say PR 100? Is the physician non-assigned w/Medicare?
Are these affecting all patient's or just QMB's?

 

[FABBOTT]

No. We've never had a problem like this before. We recently moved, and I've updated our new address with the NPI Enumerator. The take-backs seem to be affecting Oct-Nov 2017 DOS and forward. The best I can tell, it has to do with patients that are dually qualified for Medicare and Medicaid. But it's adding up to be huge amounts of money. I'm registered for the phone call on June 6, but I'm hoping to get this figured out before then. I have looked up all the codes on the RA and nothing ties to the takebacks (or non-payments). I called Medicare and they told me that they couldn't tell me anything, that all the information is provided on the RA through our clearinghouse.