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Reading Your Part B/DMERC (Physician Outpatient/Durable Medical Equipment) Claim Details
When you select the claim number link from the Search Results page, you can view more details about the claim, including an itemized list of each procedure billed to that claim.
Each type of claim shows different information associated to the type of service performed. You can see the type of claim by looking at the Claim Type entry under the Claim Information heading.
The following information is available for Part B Physician Outpatient and Durable Medical Equipment Claims:
- Start Date - The date that service for this claim started
- End Date - The date that service for this claim ended
- Claim Number - The Medicare claim number for this claim
- Provider Name - The name of the provider that performed the service
- Claim Processed Date - The date the claim was processed
- Claim Received Date - The date the claim was received
- Assigned / Unassigned - The assignment status for this claim (A=Assigned; U=Unassigned). Providers who accept assignment agree to accept the Medicare approved amount as total payment for covered services. Medicare pays its share of the approved amount directly to the provider. You may be billed for unmet portions of the annual deductible and the coinsurance. Doctors who submit unassigned claims have not agreed to accept Medicare’s approved amount as payment in full. Generally, Medicare pays you 80% of the approved amount after subtracting any part of the annual deductible you have not met. A doctor who does not accept assignment may charge you up to 115% of the Medicare approved amount. This is known as the Limiting Charge. Some states have additional payment limits. The NOTES section on your Medicare Summary Notice will tell you if a doctor has exceeded the Limiting Charge and the correct amount to pay your doctor under the law.
- Referring Provider Name - The name of the referring physician
- Total Amount Charged - The total amount charged by the provider and submitted to Medicare
- Total Applied to Deductible - The total amount of the claim that was applied to the deductible
- Blood Deductible - If applicable, there will be one or two numbers in this field. The first (or only) number represents the total number of pints of blood that was applied to your blood deductible from this claim. The second number, if any, represents the remaining number of pints to meet your blood deductible for that benefit period (year)
- Psychiatric Charges - The amount applied towards the Psychiatric Therapy amount for the period, if applicable
- Physical Therapy Charges - The amount applied towards the Physical Therapy amount for the period, if applicable
- Occupational Therapy Charges - The amount applied towards the Occupational Therapy amount for the period, if applicable
- Medicare Approved - The amount of the Medicare payment
- Medicare Paid You - The amount paid to the beneficiary
- Medicare Paid Provider - The amount paid to the provider
- Total Amount You May Be Billed - The dollar amount that the beneficiary is responsible for paying. This amount includes deductibles, co-insurance and/or charges for services or supplies that are not covered by Medicare.
Please Note: The claims listed are claims which have been received and processed by Medicare. If you do not see a claim that you searched for, please check back at a later time when Medicare has received or processed your claim.
Understanding Procedure Details
The Procedure Details section contains information on each procedure itemized in this claim:
- Claim Line # - Identifies each line item in the claim
- Procedure Code - The code and description of the performed procedure
- Total Units - The total number of units billed
- Start Date - The date on which service took place
- Revenue Code - The revenue code associated with the procedure
- Medicare Approved - The dollar amount that Medicare allows for this procedure (covered charges)
- Amount Charged - The total dollar amount billed by the provider
- Cash Deductible - The dollar amount from the procedure applied to the deductible. This amount should be paid to the provider.
- Co-Insurance - The portion of this procedure that the beneficiary is responsible for paying
- You May Be Billed - The dollar amount that the beneficiary is responsible for paying. This amount includes deductibles, co-insurance and/or charges for services or supplies that are not covered by Medicare.