If it seems that the specifications FA0 forever, they do quite a lot. In this medical billing rate, based on the electronic billing of claims using NSF 3 / 01 specifications, we will FA0 Record Fields 48 to 55.

FA0 field 48, position 224 - 230, is required to provide the amount. If that sounds strange, like English, then a little explanation is in order. In the settlement of a medical institution or entity, such as Medicare, most doctors are so-called participating providers. This means that they are the universal Medicare program. As the vendor involved, one of the things that they are bound, the charges that the administration of Medicare for individual services. By accepting this agreement, if a bill to Medicare, there is what they call an obligation amount. This means that regardless of what the doctor wants, for the service, which is the amount he agreed to Medicare, if the payment. This is the amount that is transferred in this field.

FA0 field 49, positions 231 to 237, the drug rebate amount. For claims where there are drugs or medications, is the amount of the discount that the patient is entitled to for that particular drug. This field is not too often, but it is in place and operational.

FA0 field 50, position 238, is the nature of the indicator units. This is an indicator that is also rarely used to show how the units are billed, regardless of whether it is box, carton or unit.

FA0 field 51, position 239 - 245, is the approved amount. When all is said and done, this is the amount which after approval by the contracting authority, regardless of whether it is Medicare, Medicaid, or private entities. In most cases this is the amount that is sent to the provider or the patient.

FA0 field 52, position 246 - 252, is the amount paid. This is the amount for this claim when it billed, before, that was already paid. In most cases, there will be a first exposure to this field and will have all zeros. It must be filled out and can not be left blank or the claim will be denied.

FA0 field 53, position 253 - 259, is the recipient liability amount. This is where things get a little hairy. If a claim is not paid in its entirety, and it is an amount to be borne by the patient and the patient is no longer live (patient do during the process) This is the amount that the recipient patient is responsible for the payment. This will be done in areas of law, we are not touching.

FA0 field 54 and 55, positions 260 to 273, the balance billing limit free amount and percentage fields. This is also in a zone that is beyond the scope of this article. Let's just say that it is rare that these fields are used, so let's just leave it at that.

In our next installment on medical billing of electronic claims, we will pick up with FA0 Field 56th

Michael Russell

Your independent guide to Medical Billing