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Back  RFI # 1488: Bad Debt/Charity pat resp 835

Formal vs. Informal Help Informal Formal

Submitter

Barber Meg

Description

I can't locate in the guide or in RFI advise on how to report Patient Pools. - Bad Debt and Charity - this the amount that the patient is responsible for in addition to regular cost share. Can you avise a CAS code to use or is there a way to report the patient pools in the 835 ERA.

Submitter Assigned Keywords

Bad Debt and Charity - 835 ERA reporting

Response

Scenarios where payers contribute to specific "public goods funds", e.g. NYHCRA Bad Debt and Charity (Indigent Care) should be reported using CARC 137 (Regulatory Surcharges, Assessments, Allowances or Health Related Taxes). In situations where the patient is responsible for the amount, this amount should be reported separately from any other patient liability (e.g. coinsurance), using CAS*PR*137. Since there are some situations where the patient is responsible for part or all of the amount, and other situations where the provider is responsible, the group code used may vary.

Information pertinent to this topic will be reviewed to provide additional clarification and instruction in a future version of the guide.
Submission 1/4/2012
Status Date 2/23/2012
Status F - Final
Primary References
Document 005010X221
SectionN/A