Medical Billing - FB0 Record Fields 8 Through 14

By: Michael Russell
Submitted: 2007-01-17 15:33:57
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In this installment on medical billing of electronic claims, using NSF 3.01 specifications, we're going to continue our review of the FB0 record, which is more line item detail, picking up with field number 8.

FB0 field 8, positions 61 - 67, is the coinsurance amount. This is the amount of the claim that is covered by any additional insurance that the patient has. In the most common cases where you're billing Medicare, the secondary payer will be Medicaid and this amount will usually be the 20% that Medicare doesn't cover. Of course this isn't always the case.

FB0 field 9, positions 68 - 82, is the ordering provider ID. I think we need to take a moment to clarify something that is probably confusing a lot of people. In this series of articles, we've seen many ID numbers for providers, including rendering, referring and now ordering. The difference between these three is very easy to explain.

The rendering provider is the provider who actually performs the procedure or gives treatment to the patient. The referring provider is the one who referred the patient to the provider who actually performed the procedure. The ordering provider is the one who made the determination that the procedure needed to be done. In many cases, the ordering and rendering provider are the same but in some cases the rendering provider brings in a consultant for an expert opinion. This provider will sometimes make the call and thus becomes the ordering provider and is paid for his services, little as they may have been. Field 9 transmits the ordering provider ID to the payer. If it is the same as the rendering provider then the same ID number is transmitted here. Hope this didn't confuse anyone.

FB0 field 10, positions 83 - 84, is the ordering provider state. In some cases, a consultant is called in from another state so this field doesn't have to match the same field for the rendering provider.

FB0 field 11, positions 85 - 99, is the purchase service provider ID. If, for this claim, a special purchase had to be made of some equipment from an outside provider, his ID needs to be filled in here because he also needs to be paid for his services. Yes, everybody gets a piece of the pie when it comes to medical billing. Even the guy who just changes your sheets in the morning.

FB0 field 12, positions 100 - 101, is the purchaser service state. This is the state where the service item was purchased from. This must be filled in even if it is in the same state as the one where the service was performed. If it's a different state, then state taxes come into play here.

FB0 fields 13 and 14, positions 102 - 109, are pen grams of protein and pen calories. Pen grams of protein are the amounts of amino acids that are prescribed to the patient daily and pen calories are the number of calories in those proteins. These fields are conditional.

In our next installment on medical billing of electronic claims, we'll continue our review of the FB0 record with field number 15.

Article source: Expert Articles