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Dream Factory by TruBridge Ideas Portal
Status Product Owner Review
Categories AR | Revenue Cycle
Created by Clarissa Calhoun
Created on Jul 20, 2023

Medicare RHC Billing CG Modifier / Receipting Auto Adjust Billed Amount & Contractual

CG Modifiers on Medicare RHC Claims - Report modifier CG on one revenue code 52X or 900 service line, which includes all charges subject to coinsurance and deductibles. This modifier indicates which service line should receive the all inclusive rate and be subject to deductibles and coinsurance. Additional service lines are charged on patient's account with charges greater or equal to $0.01. Insurance claim gets billed out of Thrive looking like the total claim charged amount does not match the total charges on the patient account. Additional service lines are informational purpose only. This needs to be address in insurance billing process. Or have the system auto adjust during insurance receipt posting.


This creates a tedious process for posting Medicare RHC Claim manually. Manually Posting in Thrive (3 options):

  1. Overstate the contractual when posting the remit manually.

  2. Post the receipt like normal allowing a credit to hit the account then immediately posting another insurance receipt but only for a contractual adjustment utilizing a unique GL that is only for RHC receipt corrections.

  3. Post the receipt like normal allowing a credit to hit the account then post an adjustment charge on the account and wash the credit.


Need to come up with an easier way either within insurance billing setup and/or insurance receipting to auto adjust billed and contractual amounts. Currently taking too many steps to post Medicare RHC Remits.




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