Clarification on Submission of the Correct “Amount Paid” on Assigned Claims - Item 29 of the CMS-1500 Claim Form or Electronic Equivalent

Posted March 16, 2012

The following instructions apply to "Assigned" Claims Only.

Suppliers are reminded that Item 29 of the CMS-1500 Claim Form or the electronic equivalent is to be completed with the "total amount the patient paid on the covered services only." Any beneficiary payment amount collected for the specific covered items submitted on the claim, (i.e., coinsurance and deductible) should be reflected with the claim submission. Suppliers should not report any money collected on noncovered items, upgraded items, or items expected to be denied as not reasonable and necessary with an ABN on file. In the event Medicare is the secondary payer, suppliers should not report any primary insurance payments in the "Amount Paid" field.

Suppliers are encouraged to follow the instructions above to ensure the beneficiary's Medicare Summary Notice (MSN) reflects the proper payment due to the supplier and any Medicare payment over the total patient responsibility amount will be sent to the beneficiary.

The DME MACs remind suppliers, there is never any certainty if a deductible will or will not be applied to the claim in question. The deductible will be applied based on the first claim to complete processing and not necessarily the claim with the earliest "date of service" in the year. The information available through the eligibility systems is only as current as of the date received and not a guarantee the deductible will be applied to a specific claim. Therefore, suppliers are strongly encouraged to wait and collect the deductible after a claim has been finalized and included on the remittance advice.

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