Medical Billing - HA0 Record

In this installment on medical billing, we're going to review one of the shortest and yet one of the most confusing records for electronic billing of claims using NSF 3.01 specifications. This is the HA0 record. Curious as to what all the fuss is about? Keep reading and you'll find out.

The HA0 record doesn't really consist of very much. As a matter of fact, going over the individual fields is almost pointless. The first field is the standard record type, which in this case is HA0. The second field is the sequence number in the claim, which we also see in all other records. The third field is the patient ID, which is in every record that transmits patient information. The fourth field is the line item control number, which in this case isn't even used yet. All that is new in this record is field five, which falls between positions 40 and 320. The field is labeled as extra narrative. So how much trouble can this field possibly cause?

To understand this, one must first understand the legal speak that goes along with the HA0 record. If you carefully read the Medicare manual, it clearly states, for the description of this field, "Free form narrative record to submit additional information that may assist in the adjudication of the service line item in the proceeding FA0 record".

To further understand this description, one must first understand the reason behind it as it is not clearly stated in the manual. The reason for this is very simple. Nobody is going to outright call a doctor or billing agency a crook. But like it or not, unethical billing practices do go on. Doctors prescribe treatments that are not needed and billers blindly go ahead and bill for them. This is nothing new. It has been going on for a long time. So in order to crack down on these unethical practices, the insurance carriers are requiring extra narrative explanations in order to justify why a certain treatment is performed or a certain item is being given to a patient.

Probably one of the biggest areas of fraud is with wheelchair claims. Patients are being given wheelchairs and these wheelchairs are being billed to Medicare simply because the patient wants one, regardless of whether or not the patient really needs one. What constitutes need? This is a heated debate that will probably go on until the end of time. Some carriers say a patient must be totally unable to walk. Others say that the patient must have at least minimum mobility. What is minimum mobility? That is the problem. Too many of these claims are open to interpretation. This is why extra narrative information is required so that the carrier can get a clearer picture of why the wheelchair, or other item is being prescribed.

Is it a perfect system? No. But the HA0 record does help. Can this information also be fabricated? Of course. But at least billers and doctors now have to come up with good reasons why the patient is getting the treatment being prescribed.

In our next installment of medical billing, we'll cover another NSF 3.01 record specification.

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

Michael Russell Your Independent guide to Medical Billing

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