Medical Billing concept - Type of payments

What are the payments we have ?


Hello Friends,
Other than regular insurance payment we need to know other payments also. They are

Offset:

· If there is an adjustment in an EOB shown by the insurance company of a claim previously paid incorrectly and now they are taking back that amount. Its called offset.


Advance Payments:

The following category of payments are posted as advance payments:
· If the patient makes payment of co-pay at the time of service.


Refunds:

The following category of payments are posted as refunds:
· If the same carrier has paid the claim twice.
· Payment received from a carrier for a claim already paid by another carrier.
· Payment received from both the carrier and the patient.

· If the patient has paid for the same ticket twice.

Interest:

The following category of payments are posted in interest:
· If in an EOB there is an additional payment made apart from the allowed amount denoting interest for delay in payment

Capitated Payments

The following category of payments are posted under this heading:
· If any payment has been received for a capitated patient (which the insurance has paid the doctor under the agreement.) it has to be posted here.

Incentive

The following category of payments are posted under this heading:
· Additional payments received from Medicare due to the facility being in a HPSA (Health Professional Shortage Area). These are areas that are shortage of doctors. These areas may be in rural villages or in a big city. It may be the whole state of just a small town. The providers get 10% bonus on Medicare payment for services rendered in these areas. In order to get this bonus, we need to put a “QU” modifier in the claim if service was rendered in an urban area and “QB” modifier if service was rendered in a rural area.


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