The DME MACs have released a list serve that has been picked up by several media outlets regarding the information suppliers should include in Item 29 of the claim form. The list serve indicates that: any beneficiary payment collected for the specific covered service, (i.e., coinsurance and deductible) should be reflected with the claim submission. However, we strongly recommend that suppliers refrain from following this guidance, specifically as it relates to coinsurance and deductible amounts, while we seek additional clarification from the DME MACs.
Suppliers have historically been told not to put any dollar amounts in Item 29, unless the patient has remitted payment up front for a non-assigned claim. The reason for this is that when the claims processing system sees a dollar amount in Item 29, it is generally assumed that the patient paid for a covered service and that the patient, not the supplier, should be sent a check for reimbursement.
MiraVista is actively seeking a clarification from the DME MACs regarding this guidance and will provide an update as soon additional information becomes available.