Questions billers ask › What Information Does a Medicare Remittance Advice Include?
What Information Does a Medicare Remittance Advice Include?
The rule, word for word
“MACs shall promote the use and understanding of the Remittance Advice (RA) as an educational tool for communicating claims payment information to providers. When MACs receive and process claims, they send providers an RA, which is a notice of payment and adjustment. An adjustment refers to any change that affects how MACs pay a claim differently from the original billing, including denied claims, zero payments, partial payments, reduced payments, applied penalties, additional payments, and supplemental payments. Claim Adjustment Reason Codes and RA Remark Codes are two important non-medical code sets that communicate adjustments and explain why MACs paid a claim or service line differently than the provider billed. The official ASC X12 website provides descriptions for both code sets. When CMS doesn’t instruct MACs to use specific Claim Adjustment Reason Codes and RA Remark Codes to communicate claim payment and adjustment information, and when a code would help reduce provider inquiries, MACs shall use appropriate codes. MAC provider inquiry, POE, and systems staff shall collaborate to identify Claim Adjustment Reason Codes and RA Remark Codes that help communicate adjustments and reduce provider inquiries. MACs shall also promote the use of the free Medicare Remit Easy Print (MREP) software to obtain Electronic Remittance Advice (ERA). MREP software provides several [...]”
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What our AI found in the sources
A Medicare remittance advice (RA) is the notice MACs send providers after processing a claim, explaining payment and any adjustments -- including denials, zero payments, partial or reduced payments, penalties, and additional/supplemental payments. It conveys this information through three code elements used in combination: a Claim Adjustment Group Code (which assigns financial responsibility to the provider or beneficiary), a Claim Adjustment Reason Code or CARC (which explains the general reason payment differs from the billed amount), and, when more detail is needed, a Remittance Advice Remark Code or RARC (which adds specifics or, when it stands alone starting with "Alert," conveys general informational messages). RAs are issued either electronically as the HIPAA-standard ASC X12 835 transaction or, for providers who can't or choose not to get an ERA, as a Standard Paper Remittance (SPR).
Also cited
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If this comes up on one of your claims
The quoted paragraph above is what you would put in the appeal or the audit file, with its citation and dates. Verbatim does not tell you how to bill; it shows you the rule as published so the decision is yours and the proof is in writing.
Ask it your own question and get the same thing back: the governing rule, quoted, with a citation that still verifies later.
Ask Verbatim your question