Disclaimer: This information is for educational purposes only. It does not constitute legal advice. Consult a qualified attorney for advice on your specific situation.
Detailed Answer
In Mississippi, a standard statement of account (also called a billing statement) breaks down balances into four main sections: gross charges, contractual adjustments, payments (credits), and the remaining patient balance. Insurance company or government program payments appear in the Payments/Credits section. This section sits directly after contractual adjustments and before the final amount owed by the patient.
Here’s how the flow works on a typical statement:
- Gross Charges: Lists all services and corresponding rates charged by the provider.
- Contractual Adjustments: Reflects the negotiated write-offs or discounts under your insurance or program contract. These line items reduce the gross charges.
- Payments/Credits: Shows the amounts actually paid by third-party payers, including private insurers, Medicare, Medicaid, or other government programs. Each entry lists the payment date, payer name (e.g., Blue Cross Blue Shield, Mississippi Medicaid), claim reference number, and amount.
- Patient Balance: The remaining amount after adjustments and payments. This is what you owe personally.
For Medicaid providers, the Mississippi Division of Medicaid’s provider manual explains how to report payments and remittance advice. See Mississippi Division of Medicaid Provider Manual: medicaid.ms.gov/providers/provider-manuals/.
For Medicare, follow the U.S. Centers for Medicare & Medicaid Services guidance on remittance advice and electronic payments: cms.gov/Manuals.
Helpful Hints
- Review the “Payment Summary” or “Credits” section to see insurer and government payments.
- Match each payment entry with explanations of benefits (EOB) or explanation of payment (EOP) documents.
- Note the date and reference number to track any denials or pending issues.
- Verify that contractual adjustments reflect your negotiated rates under Mississippi Code § 83-11-101 et seq. for prompt payment standards.
- Contact the payer’s customer service for discrepancies or missing payments.