Contractual adjustment is a phrase commonly used in health insurance when an insured person is covered by an individual or group health plan that involves a network of providers contracted by the insurer. Contractual adjustments generally reduce the amount of the service charge, thus reducing the amount owed on the claim.
A Contractual Adjustment is a part of a patient’s bill that a doctor or hospital must write-off (not charge for) because of billing agreements with the insurance company. Adjustments, or write-off’s, are the dollars that are adjusted off a patient account for any reason. The Contractual Adjustment is the most common type of adjustment.
Define Contractual Adjustment. means, with respect to any Receivable, an amount by which the outstanding principal amount of such Receivable is reduced as a result of (i) Medicare or Medicaid program funding and fee requirements or (ii) any other reasonable and customary insurance company or other charge or reimbursement policies or procedures.
Equitable Adjustment – A contract modification, usually to contract price, that ….. 2) If the contract defines a term, use the definition contained in the contract itself … (CPI) for Contract – Bureau of Labor Statistics
The contractual adjustment is the dollar difference between what the hospital or physician billed and what Medicare has approved for payment. The amount is customarily written off by the healthcare provider who accepts Medicare assignment.
Medicare Contractual Adjustment. PDF download: R470CP.pdf – CMS. www.cms.gov. Feb 4, 2005 … reason code, CMS has never permitted Medicare contractors to use this … TS311 (Total contractual adjustment)—This must equal the sum of all … Medicare Claims Processing Manual – CMS. www.cms.gov
Contractual definition is - of, relating to, or constituting a contract. How to use contractual in a sentence.
An adjustment amount identified by an ARC not included in this list is not considered a contractual adjustment. Reporting Contractual Adjustments MDCH strongly encourages submission of electronic claims, as the UB-92 claim form does not accommodate reporting contractual adjustment amounts. For electronic claims, the total contractual adjustment ...
CONTRACTUAL ALLOWANCE, in healthcare, is the difference between what hospitals bill and what they receive in payment from third party payers, most commonly government programs; also known as contractual adjustment. Learn new Accounting Terms. CREDIT MEMO is a document used to issue a vendor credit.
Contract adjustment Equitable adjustment : In government contracting. Claim agent: An employee of a railroad company, a business, or an industry, whose duty it is to investigate claims made against his employer and report to the employer whether a claim should be paid, denied, or adjusted.