View the Medicare Part B Expected Reimbursement Detail

Use the following procedure to view the Medicare Part B Expected Reimbursement Detail.

Note: If the Expected Reimbursement Detail is incomplete, click a Service Type link.

The following table describes each of the fields on the Expected Reimbursement Detail page for Medicare Part B claims. The fields are listed in alphabetical order.

Field	Description
Actual Payment (RA)	The total insurance and patient payments posted to the accounts, as defined in the data and used for used for Remittance Advice purposes
APC Codes	Ambulatory Payment Classification codes
Billed Units	Number of units billed
Charges	Total amount billed by the provider
Charges (RA)	Total amount billed used for Remittance Advice purposes
Claim Disposition	Disposition code for claim level
Claim Error	Error code for the claim level
CPT/HCPCS Codes & Modifiers	Associated CPT or HCPCS codes and modifiers
Error Code	Reason for rejection or return, if applicable
Expected Payments	The calculated reimbursement based on the predefined contract terms and conditions and service type definitions in the system and the repriced claims data
Fee Schedule Payment	Total reimbursement from a fee schedule (Lab, DMEPOS, PEN and therapies)
Medicare APC Payment, Excluding Outliers	APC portion of the amount Medicare would pay, minus outliers
No.	Sequential reference number of the line item
Outlier Amount	Total amount for extraordinarily high cost (cost outlier) for that service date
Pass-Through Payment	Total reimbursement for certain high-cost items like implants, high cost drugs and biologicals for which the actual or higher cost is passed through to the payor
Payment Codes (RA)	Used to explain the payment of the account; defined in the Remittance Payment Codes table
Payment Status Code Definitions	Definitions of Payment Status Codes listed
RA Claim Status	Explanation of the RA claim status code used in the Reimb. column
Reimbursement Type	Reimbursement type, either expected reimbursement or RA, if applicable (the latest RA is shown if there are multiple RAs)
Remittance Advice Payment Code Descriptions	Descriptions of Remittance Advice Payment Codes listed
Rev Code	Revenue code
Service Dates	Dates the service was rendered
Status Code	APC payment status code
Total Claim Outlier Amount	Total amount for extraordinarily high cost (cost outlier) for all service dates
Total Deductible	Total deductible
Total Medicare Payment	Total Medicare payment
Total Patient Responsibility	Patient co-payment, as stipulated by the rules
Total Payment by APC	Payment by APC for the line item
Total Payments, Including Outliers	Total expected amount from Medicare
Units (RA)	Number of units used for Remittance Advice purposes