Importance of Box 28 – CMS 1500
When not to show patient paid amounts on claims form in Field 28
Some providers who accept assignment have a concern that Medicare issues partial checks to beneficiaries. Such checks are generally issued because of a patient paid amount in item 28 of the CMS-1500 (08/05) claim form. Here are a few notes concerning this situation:
• When assignment is accepted, Medicare Part B recommends:
• Since it is difficult to predict when deductible/coinsurance amounts will be applicable – and over-collection is considered program abuse – it is recommended that providers do not collect these amounts until Medicare Part B payment is received.
• If you believe you can accurately predict the coinsurance amount and wish to collect it before Medicare Part B payment is received, note the amount collected for coinsurance on your claim form. It is recommended that providers do not collect the deductible prior to receiving payment from Medicare Part B because, as noted above, over-collection is considered program abuse. In addition, this practice can cause a portion of the provider’s check to be issued to beneficiaries on assigned claims.
• Do not show any amounts collected from patients if the service is never covered by Medicare Part B or you believe, in a particular case, the service will be denied payment. Where patient paid amounts are shown for services that are denied payment, a portion of the provider’s check may go to the beneficiary.
• There is no need to show a patient paid amount in item 28 of form CMS-1500 (or electronic equivalent) when assignment is not accepted.
When not to show patient paid amounts on claims form in Field 28
Some providers who accept assignment have a concern that Medicare issues partial checks to beneficiaries. Such checks are generally issued because of a patient paid amount in item 28 of the CMS-1500 (08/05) claim form. Here are a few notes concerning this situation:
• When assignment is accepted, Medicare Part B recommends:
• Since it is difficult to predict when deductible/coinsurance amounts will be applicable – and over-collection is considered program abuse – it is recommended that providers do not collect these amounts until Medicare Part B payment is received.
• If you believe you can accurately predict the coinsurance amount and wish to collect it before Medicare Part B payment is received, note the amount collected for coinsurance on your claim form. It is recommended that providers do not collect the deductible prior to receiving payment from Medicare Part B because, as noted above, over-collection is considered program abuse. In addition, this practice can cause a portion of the provider’s check to be issued to beneficiaries on assigned claims.
• Do not show any amounts collected from patients if the service is never covered by Medicare Part B or you believe, in a particular case, the service will be denied payment. Where patient paid amounts are shown for services that are denied payment, a portion of the provider’s check may go to the beneficiary.
• There is no need to show a patient paid amount in item 28 of form CMS-1500 (or electronic equivalent) when assignment is not accepted.