Payment/Reimbursement FAQs
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- I'm having problems understanding the information printed on the remittance advice (RA). Where can I find more information on how to read it?
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The Centers for Medicare & Medicaid Services (CMS) has issued the "Reading the Institutional Remittance Advice (RA)" Booklet
, which is designed to provide education on the institutional remittance advice (RA). It includes screen shots of an institutional RA with an explanation of what you will find on each screen. Additional CMS resources include:- "Remittance Advice Information: An Overview" Fact Sheet

- "Remittance Advice Resources" Fact Sheet

- "Remittance Advice Resources and Frequently Asked Questions (FAQs)"

- Health Care Payment and Remittance Advice

In addition, CGS offers an interactive electronic remittance advice (ERA) and standard paper remittance (SPR) advice that provides information about each field on the ERA/SPR. Refer to the Remittance Advice (RA) / Electronic Remittance Advice (ERA) Web page to access the interactive tools, as well as additional resources.
Reviewed: 03.09.17
- "Remittance Advice Information: An Overview" Fact Sheet
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- Is there any way we can verify whether our Medicare claims paid correctly other than calling CGS for a payment explanation?
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For providers who are paid under a Prospective Payment System (PPS), such as home health agencies, refer to the Centers for Medicare & Medicaid Services (CMS) PC Pricer Web page
, which contains PPS pricing information. By downloading the free versions of the Pricer for their provider type, providers can predict payment for services they plan to provide, calculate the payment they will receive for an individual claim or validate they have received the correct payment for an individual claim.For hospice providers, the 'Hospice Payment Rates' webpage contains links to the Hospice Rates and the Hospice Wage Index files, as well as a Hospice Payment Rates Calculator.
Reviewed: 03.09.17
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