To determine how much Medicare paid on a claim before billing secondary insurance, which document should be consulted?

To determine how much Medicare paid on a claim before billing secondary insurance, which document should be consulted?

• A. Remittance Advice
• B. EOB from the patient
• C. Provider contract
• D. Preauthorization letter

Answer: (A)

When you need to know Medicare’s actual payment before the secondary insurer comes into play, look at the payer’s payment record that details how the claim was settled. The Remittance Advice from Medicare itemizes the payment, adjustments, and the patient’s remaining responsibility, so you can see exactly what Medicare paid before any secondary billing occurs. The information on this document is what tells you the true Medicare contribution to the claim. The EOB from the patient is a beneficiary-facing explanation and may reflect the secondary plan’s or patient’s portion, not Medicare’s official payment details. A preauthorization letter relates to service approval and does not include payment amounts. A provider contract covers negotiated rates and terms but does not show the actual amount paid on a specific claim.

When you need to know Medicare’s actual payment before the secondary insurer comes into play, look at the payer’s payment record that details how the claim was settled. The Remittance Advice from Medicare itemizes the payment, adjustments, and the patient’s remaining responsibility, so you can see exactly what Medicare paid before any secondary billing occurs. The information on this document is what tells you the true Medicare contribution to the claim.

The EOB from the patient is a beneficiary-facing explanation and may reflect the secondary plan’s or patient’s portion, not Medicare’s official payment details. A preauthorization letter relates to service approval and does not include payment amounts. A provider contract covers negotiated rates and terms but does not show the actual amount paid on a specific claim.