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National Government Services, Inc.
 Medicare Monthly Review Part A and B
A Combined Part A and Part B Newsletter
MMR-2008 03A, March 2008

MLN Matters. . .Information for Medicare Providers
(Issued by the Centers for Medicare & Medicaid Services)

New Value Code to Report Patient Prior Payments

MLN Matters Number: MM5882
Related Change Request (CR) #: 5882
Related CR Release Date: February 1, 2008
Effective Date: July 1, 2008
Related CR Transmittal #: R1427CP
Implementation Date: July 7, 2008

Provider Types Affected
Hospitals, home health agencies, and other providers who bill Medicare contractors (fiscal intermediaries (FI) regional home health intermediaries (RHHI), or Medicare Administrative Contractors (A/B MAC)) for services provided to Medicare beneficiaries

What You Need to Know
CR 5882, from which this article is taken, announces the creation of a new value code for the Medicare Form UB-04 (CMS-1450). This new code, Value Code FC – Patient Prior Payment, will enable you to continue to report patient prior payments (the amount you received from the beneficiary toward payment of the submitted claim prior to the billing date). Make sure that your billing staffs are aware of the creation of this new value code, and that they know to implement it effective July 1, 2008.

Background
Previous Medicare Form CMS-1450 billing instructions for form locator (FL) 54 allowed providers to report the total amount of payments toward deductibles and/or coinsurance that they had collected from a patient for all services other than inpatient hospitals or skilled nursing facilities (SNF). However, with the implementation of the UB-04, the National Uniform Billing Committee (NUBC) eliminated “Patient” from FL 54; which is now used to report prior payer payments.

To enable Medicare providers to continue to report patient prior payments, the Centers for Medicare & Medicaid Services (CMS) asked the NUBC to create a value code for this purpose. NUBC approved this request on 11/14/2007; and CR 5882, from which this article is taken, announces the creation of this new value code: Value Code FC – Patient Prior Payment.

Additional Information

You can find CR 5882 at http://www.cms.hhs.gov/Transmittals/downloads/R1427CP.pdfExternal PDF on the CMS Web site. There is also information in the Medicare Claims Processing Manual, Chapter 25 (Completing and Processing the Form CMS-1450 Data Set), on completing the UB-04. This manual is available at http://www.cms.hhs.gov/Manuals/IOM/list.aspExternal Link on the CMS Web site. If you have any questions, please contact your FI, RHHI, or A/B MAC at their toll-free number, which may be found at http://www.cms.hhs.gov/MLNProducts/downloads/CallCenterTollNumDirectory.zip Zip File on the CMS Web site.

Disclaimer
This article was prepared as a service to the public and is not intended to grant rights or impose obligations. This article may contain references or links to statutes, regulations, or other policy materials. The information provided is only intended to be a general summary. It is not intended to take the place of either the written law or regulations. We encourage readers to review the specific statutes, regulations and other interpretive materials for a full and accurate statement of their contents. CPT only copyright 2007 American Medical Association.