Top Management Story

Writen by Michael Russell

In this final installment of medical billing of electronic claims, using NSF 3.01 specifications, we're going to cover the last fields of the FB0 record. Before we do that though, there is something that should be pointed out not only about the FB0 record but about all line item detail records, which include FA0, FB0, FB1 and FB2 records.

Many people in the industry feel that the amount of information transmitted in regard to line item detail is overkill. The majority of professionals who work in the field of medical billing feel that the item description, item number and price is all that should need be transmitted in addition to the patient the drug, item or procedure is being billed for. There are pros and cons to this argument that we're going to touch on briefly.

The pros are obvious enough. With a decrease in the amount of information that is transmitted, the cost of medical billing will go down. While many people think that doctors are mostly responsible for rising medical costs, as well as the drug manufacturers who charge insane amounts of money for one pill, the truth is, medical billing costs are greatly responsible for the overall increase in medical costs in general. The red tape involved with processing most claims doesn't help to reduce costs any. And let's be honest, the billing companies and the companies that provide billing services and software want to get their piece of the pie too. So the more information that needs to be transmitted, the more money they can charge for the service. By reducing the amount of information that needs to be sent, you not only reduce costs but you also get rid of a lot of the red tape.

The cons are not quite as obvious because most people don't realize what sending all this information does. For one thing, it helps cut down on medical fraud, which is a growing problem in this country. By requiring more information to be transmitted, it makes it more difficult for a biller to commit fraud, as well as the patient. Those who think that there aren't claims filed that aren't legit are living in a world that doesn't exist. Medical fraud is one of the worst problems in the United States and gets worse every year. The other problem with cutting down on the amount of information that needs to be sent is that it will ultimately put people out of work. This does nothing but add to the unemployment problem, which is already bad enough.

Like it or not, this overkill of information is here to say. With that, let's wrap up our review of the FB0 record.

FB0 fields 27 - 32, positions 182 - 313, is the purchase service company info, which includes their name, address and phone. This information needs to be provided so that the payer can verify with the company that the purchase actually happened. Again, this goes back to the fraud problem. Most people would have this info eliminated.

FB0 field 33, positions 314 - 316, is the drug number of days supplied. This is the number of days that the drug that was prescribed for. This must match the number of units per day to the total number of units prescribed.

FB0 field 34, position 317, is the payment indicator type and is not supported.

FB0 field 35, positions 318 - 320, is filler national and must be left blank.

This finally concludes our review of the FB0 record. In our next installment of medical billing, we will begin our review of the FB1 record.