Monday, June 7, 2010

Electronic claim submission LOOP 2300

Loops and Segments Table - Loop 2300 - Claim Information

Contract Information

Usage : Situational
Element : CN101
Value :
01 = Diagnosis Related Group (DRG)
02 = Per Diem
03 = Variable Per Diem
04 = Flat
05 = Capitated
06 = Percent
09 = Other

Comment :Code to identify a contract type.


Usage : Situational
Element : CN102
Value : Nil
Comment : The amount of the contract agreement (Obligated to Accept as Payment in Full Amount).
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Medicare physician fee schedule - Quick overview

Medicare Part B pays for physician services based on the PFS, which lists the more than 7,400 unique
covered services and their payment rates. Physicians’ services include the following:

* Office visits;
* Surgical procedures;
* Anesthesia services; and
* A range of other diagnostic and therapeutic services.


Medicare Physician Fee Schedule Payment Rates

Payment rates for an individual service are based on
three components:
1) Relative Value Units (RVU)
2) Conversion Factor (CF)
3) Geographic Practice Cost Indices (GPCI)


Medicare Physician Fee Schedule Payment Rates Formula


The Medicare PFS payment rates formula is shown below:

[(Work RVU x Work GPCI) + (PE RVU x PE GPCI) +
(MP RVU x MP GPCI)] x CF

Medicare fee schedule download