The beneficiary called and complained about an outpatient hospital claim for date of service 8/1/00. He wants to know why the coinsurance amount seems so high?
Your facility may have had low charges for the service rendered when claims processed under the old system that was based on the billed charge. Under the Outpatient Prospective Payment System, effective 8/1/00, the coinsurance or fixed copayment amount for services may be higher now that they are calculated based on the ambulatory payment classification (APC) group for that service rather than the billed charge.
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