tinalm wrote on Wednesday, May 15, 2013:
I’ve looked through all the documentation, etc., and can’t figure out a good way to account for the sequestration amounts.
So Medicare was supposed to pay $20 and now they’re paying $19. That leaves a $1 balance that nobody will pay. How do we handle this?
Thanks in advance!
rpl121 wrote on Wednesday, May 15, 2013:
My Medicare EOBs now contain two different adjustment codes (CO-XX). The first is the difference between charge and the allowed amount, and the second is the additional required discount because of sequestration. The total required adjustment is the sum of these. I simply add them up in my head and apply a single adjustment equal to that total. Alternatively, one could figure out the true allowed amount by taking the explicit allowed amount and subtracting the sequestration amount.
If you are using an automated method, my hunch is that you need to make the program recognize the CO code for sequestration and apply it. (I use Medisoft for charges and OpenEMR for medical records.)
tinalm wrote on Wednesday, May 15, 2013:
We use OpenEMR for both medical records and charges. I’m wondering whether there is a way to add those codes through an admin tool within OpenEMR…
fsgl wrote on Thursday, May 16, 2013:
Consider using the Batch Payments Module, entering the sequester amount as a Takeback and then choosing code 223, (“Adjustment code for mandated Federal, State or local law/regulation that is not already covered by another code and is mandated before a new code can be created”), from the MSP drop down menu.
Office Ally’s software automatically fills in the regular adjustment (CO-45), so it is not necessary to do so for secondary claims. For additional adjustments this is not always the case. You may need to speak to Support of your clearinghouse as how best to handle this new situation.
fsgl wrote on Wednesday, May 29, 2013:
In theory the Takeback should work. In practice, it does not work. Putting the sequester amount in the Takeback column results in adding 2 times the sequester amount to the balance due, therefore this method cannot be used.
The regular adjustment, CO-45, can be entered first and then the sequester adjustment, CO-223, be can entered subsequently in the EOB module.
I asked Office Ally Support how to handle the sequester adjustment. Their claims preparation software will not be able to handle the sequester amount lumped together with the regular adjustment amount, thus potentially causing rejection of secondary claims. With the separate listing of each adjustment, it would be easier to assign the CO-223 to the sequester amount, should that be necessary in fixing a claim.