Hospital manual.

  • United States Social Security Administration
Date:
1967]
Catalogue details

Licence: Public Domain Mark

Credit: Hospital manual. Source: Wellcome Collection.

    109/130 page 97
    (3) Patient has a mixture of diagnostic and thera- peutic services. For diagnostic services, charge up to $20 plus 20 percent of any balance. For therapeutic services, charge the amount necessary to meet the $50 medical plan deductible (after considering the amount of the diagnostic deductible charge as an incurred ex- pense under the medical plan) and 20 percent of any balance. (b) Medical Plan Deductible Is Met—Charge 20 percent of the total, whether the services are diagnostic or therapeutic. 2. Patient Has. Hospital Plan Entitlement Only.—Only diagnostic services are covered. Charge up to $20 plus 20 percent of any remainder and the full amount of any charges for therapeutic services. 3. Patient Has Medical Plan Entitlement Only.—Both diagnostic and therapeutic services are covered under the medical plan. Where the deductible is known to be met, charge 20 percent of the total. Where the deductible is not met or its status is unknown, charge no more than $50 and 20 percent of any balance. Here the hospital may prefer to wait to bill the patient until the intermediary has verified the deductible status. C. Billing Examples.— Example 1: Hospital knows patient has met Part B deductible. Outpatient hospital diagnostic services reasonable charge is $40. The hospital bills the patient $8 (20 percent of the total). The intermediary re- imburses the hospital 80 percent of the $20 Part-A deductible ($16), plus 80 percent of the estimated reasonable cost of the services above the $20 Part A deductible. Example 2: Patient has met Part B deductible, but hospital has not been able to ascertain that fact. Out- patient hospital diagnostic services reasonable charge is $40. Hospital bills patient $24 (the $20 Part A deductible, plus 20 percent of the remainder) . Intermediary determines by querying SSA central records that Part B deductible had been met. The intermediary reimburses the hospital for 80 percent of the reasonable cost above the $20 deductible and reim- burses the patient $16 (80 percent of the $20 Part A deductible) . Example 3: It is uncertain whether the patient has met Part B deductible. Outpatient hospital diagnostic not to bill the patient until the intermediary has veri- fied the deductible. The intermediary queries the SSA central record and determines that the patient had not met any part of the Part B deductible. It reimburses the hospital 80 percent of the estimated reasonable cost of the services above the $20 Part A deductible, and informs the hospital it should bill the patient for $24, ie., the Part A deductible, plus $4 coinsurance. Example 4: Patient has $80 in diagnostic services and $40 in therapeutic services. The hospital be- lieves the medical plan deductible is not met and decides to bill the patient at the same time the billing form is sent to the intermediary. The hospital bills the patient: $20 for the diagnostic deductible; 12 hospital plan coinsurance; 30 medical plan deductible (considering $20 diagnostic deductible as an incurred Part B expense) ; 2 coinsurance on the $10 remaining medical plan charges. $64 Total 420.1 Completing Items on Form SSA- 1483.— liem 1. Patient Identification. Enter the patient’s last name, first name, and middle initial from his health insurance card, or other notice. Item 2. Health Insurance Claim Number. Enter the patient’s claim number as shown on his health insurance card, certificate of award, utilization notice, temporary eligibility notice, or as reported by the social security district office. Item 3. Patient’s Address. Show the patient’s mail- ing address from your records. Where the patient’s authorized representative is signing the form on be- half of the patient, show the authorized representative’s address. Items 4 and 5. Date of Birth and Sex. Enter the patient’s date of birth and sex. If the date of birth is unknown, the hospital should transmit the bill with- out the date of birth. If only the year of birth is known, but not the month or day, show the year. While the date of birth is useful as identification and should be shown when available, a billing can be proc- essed. without the date of birth. Items 6, 7, and 8. Hospital Identification. Enter the name and address of the hospital and the hospital’s assigned provider number. These items can be pre- printed on all copies of this form, if desired. Enter the patient’s medical record number only if one is assigned by the hospital for its own filing purposes. Item 9. Name and Address of Physician Request-
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