Medicare Outpatient Statement
-- Description of Parts


Patient - Patient's name

Service Type - Inpatient means the patient stayed in the hospital overnight. Outpatient means services you get in one day (24 hours).

Insurance(s) - This is the insurance company with which we have filed the claim. If incorrect, please notify us immediately.

Account No. - The identification number for each patient visit or for each time the patient stayed in the hospital.

Service Date(s) - This is the date the patient received the services listed on the statement.

Bill Date - This is the date the statement printed in our data center.


Estimated Medicare payment for APC and non-APC services - The amount we expect Medicare to pay for the claim. This amount may differ from the actual amount paid by Medicare because of additional data Medicare received on the claim.

 

Estimated Patient copay & co-insurance calculated by Medicare - The amount we expect the patient to owe based on Medicare's calculation for patient responsibility. This amount may differ from your "Amount Due" because of additional data Medicare received on the claim.


Claim Summary

  • Total Amount Charged - The sum of all charges for the account.
  • Total Medicare Payment - The sum of all Medicare payments and payment reversals.
  • Total Medicare contractual - The sum of all Medicare contractual adjustments.
  • Total other insurance payments/adjustments - The sum of any payments and/or contractual adjustments received from a secondary insurance.
  • Total other adjustments - The sum of any other adjustments made on this account.
  • Patient Payments - The sum of all payments made by the patient for this account.
  • Amount due from patient - The current amount due on this account.


Services with a fixed copayment - On August 1, 2000, Medicare initiated a new payment system called the Outpatient Prospective Payment System (PPS) under which Medicare determines the fee to be charged for most (but not all) covered services. The patient is charged a fixed co-payment for the service received. These amounts will vary. The Medicare payment rate will often differ from the hospital charge amount. The approved Medicare rate may be more or less than the hospital charge amount. For more detailed information, contact Medicare (1-877-768-5471) or consult the Medicare website at www.medicare.gov.


Services with coinsurance - Services which do not fall under the new PPS system continue to be covered under the existing co-insurance system. Following is a partial list of these services: ambulance services, physical therapy, occupational therapy, speech-language therapy services, orthotics, non-implantable prosthetics, durable medical equipment, or dialysis for permanent kidney failure.

As before, the annual Medicare Part B deductible must be satisfied before benefits under either method are paid. Diagnostic Lab Services continue to be provided without patients having to make co-payments.