When you see "RA" what do you think of?

     Ra:                     Ra:                   RA:
     the Egyptian      the symbol       the abbreviation
     sun god?            for Radium?    for  Regular Army?     
                                 
                                                                                                 

Well in the realm of medical billing, RA means Remittance Advice.  An RA is the detailed reply sent by a payer in response to a claim for a medical service.  The details in the RA assist the biller in reconciling the payment that is received or provides the explanations for any non-paid items.

Many times it can also be referred to as an Explanation of Benefits (EOB).

An RA can come in two forms:

   

Standard Paper Remittance (SPR)        Electronic Remittance Advice (ERA)

Both contain similar information, but the ERA format has numerous advantages over the paper format.  Most ERA’s are received within days of the claims processing by the payer instead of the weeks in can take for the SPR to arrive via mail.   Most of the best Medical Billing Software enables ERA data to be directly imported into the billing system where it can be auto-adjudicated.  This eliminates the time consuming and error prone task of manually keying in all the data from the RA

Iridium Suite Medical Billing Software by Medical Business Systems contains an integrated automated Payment Posting module that seamlessly imports and adjudicates all of your ERA’s.

The explanation of payment on the RA is typically detailed in a “coded” fashion utilizing combinations of alpha and numeric code sets.  Medicare utilizes the most standardized version of these code sets, and they consist of four types:

• Group codes: identify the responsible party or category of adjustment and are combined with CARCs

There are five group codes: CO-Contractual Obligation CR-Corrections and Reversal OA-Other Adjustment PIR-Payer Initiated Reductions PR-Patient Responsibility

• Claim Adjustment Reason Codes (CARCs):  explain the adjustment of the non-paid amount

For a complete list of CARCs, visit Washington Publishing Company's website by clicking here. 

• Remittance Advice Remark Codes (RARCs):  provide a more detailed explanation of the adjustment of a service line or claim level payment

For a complete list of RARCs, visit Washington Publishing Company's website by clicking here. 

• Provider Level Adjustment Codes: indicate an adjustment that applies to the pay to provider, not a specific service line or a claim

Provider Level Adjustment Codesare specific to Medicare.  For a complete list, see the CMS publication by clicking here.

  Follow this link to download an informational white paper on “Understanding Explanation of Benefits Statements.”

The Medicare Learning Network in April 2013 released “Remittance Advice Information: An Overview” Fact Sheet (ICN 908325).  You can access this publication by clicking here.