Medical Billing - GD1 Record

The GD0 record for medical billing of claims using electronic transmission media is a very generic CMN. It is made to be able to handle most pieces of durable medical equipment that needs to be billed. In spite of this, there is still a supplemental record that needs to be transmitted with the GD0 record. Because the record doesn't have enough room for any other information, a GD1 record was created to send the additional information. There are only a few fields but they are critical in getting the claim paid, especially in cases where a narrative explanation is required in order to justify the item being given to the patient. We're going to briefly go over the fields themselves and explain why this narrative information may be needed.

GD1 field 1, positions 1 - 3, is the record type. This needs to be filled in with GD1. Also, it should be noted that because this record is supplemental to the GD0 record, it must come after the GD0 record in the claim file or the claim itself will be denied.

GD1 field 2, positions 4 - 5, is the sequence number. Because there can be multiple CMNs in a claim file, each CMN must have a sequence number from 01 to 99. It should also be noted that GD1-01 must come after GD0-01. The record GD1-02 would come after GD0-02 and so on.

GD1 field 3, positions 6 - 22, is the patient ID number. This must match the ID number that is transmitted in the CA0 record and all subsequent records that follow in this claim file for that particular patient.

GD1 field 4, positions 23 - 272, is the narrative information for the durable medical equipment. This is where so many claims get denied because billers don't really believe that anybody reads this stuff. They couldn't be more wrong.

Not every claim is cut and dried. There are going to be cases where a patient, who would not normally qualify for a piece of equipment, needs to have it because of very special circumstances. These reasons must clearly be stated in this field. Plus, there is also a set sequence of how the explanation needs to be made.

To start with, you must list the equipment that the patient is getting as part of the narrative. Yes, it is indicated elsewhere in the claim file but it must be listed here because the person manually reviewing this claim isn't going to go hunting through the other records.

After the equipment is listed, a detailed explanation of why the equipment is needed must be stated. This includes exactly what the patient's condition is and what the therapeutical advantages of having this equipment will be. Also, if there are any special drugs or procedures that need to be administered or followed, they also need to be clearly spelled out.

GD1 field 5, positions 273 - 320, is national filler and must be filled with spaces or the claim will be denied.

This concludes our medical billing review of the GD1 record. In our next installment of medical billing we'll cover another required CMN.

Article Source: http://www.content.onlypunjab.com

Michael Russell Your Independent guide to Medical Billing

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