Medical Billing - GU0 Record Fields 18 Through 25

By: Michael Russell
Submitted: 2007-01-17 15:35:55
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Even though there is no formal education for being a medical biller, medical billing itself can be quite complicated. There are enough rules and regulations to turn a sane man into a raving lunatic. The GU0 record does nothing to make the job any easier as it is probably the most complex CMN in the system. In this installment, we cover the GU0 record, picking up with field number 18.

GU0 field 18, positions 63 - 70, is the date of last medical exam. This field tells the carrier when the last date it was that the patient saw the doctor who prescribed this CMN. If the last date seen is before the date of the CMN, in some cases the carrier will not pay on the claim. This is why this date is required.

GU0 field 19, positions 71 - 78, is the initial date field. This field tells the carrier what the initial date of the CMN is. This is required because if the CMN is a recertification or a revised CMN, the carrier needs to know when the initial date was in order to know how to process the claim.

GU0 field 20, positions 79 - 86, is the revision or recertification date. Referring back to field 19, is this is a revised or recertified CMN, the date of that revision or recertification is transmitted here. By looking at this date and comparing it to the initial date, the carrier will know how to process the claim, depending on the item and the rules governing that item.

GU0 field 21, positions 87 - 88, is the length of need. This is the length of time, according to the physician, that the patient is going to need this item. It should be noted that this is only an estimate and not written in stone.

GU0 field 22, positions 89 - 96, is the date of signature. This field tells the carrier the date that the physician signed the CMN.

GU0 field 23, positions 97 - 106, is the ordering provider phone number. This field tells the carrier what the phone number is of the provider who prescribed this CMN. This number is needed in case the carrier needs to contact the provider.

GU0 field 24, position 107, is the certification on file field. This field tells the carrier if the actual paper CMN is on file at the provider's office. There is a lot of legal gray area involved with this field that is beyond the scope of this article. Let's just say that eventually that CMN better be on file and signed.

GU0 field 25, positions 108 - 111, is the certification form number. This tells the carrier what the exact CMN form number is. This is required because the GU0 record is created to handle a number of CMNs. In order to properly process the claim, the carrier needs to know exactly what CMN they are processing.

In our next installment of medical billing, we'll be covering the GU0 record, picking up with field number 26.

Article source: Expert Articles