Section title: Requests for Interpretation
RFI #
2299
837 negative SVD02
Description

RFI # 2114 states that SVD02 value cannot be negative value. There is an FAQ explaining an option for negative payment amount for Medicare: https://medicare.fcso.com/faqs/answers/276727.asp.
"A negative payment amount may occur in two situations:
1. When a beneficiary is charged the full Medicare deductible during a short inpatient stay and the deductible exceeds the amount Medicare pays; or,
2. When a beneficiary is charged a coinsurance amount during a long stay and the coinsurance amount plus deductible exceeds the amount Medicare pays. "
So please clarify if it's complaint with TR3 requirements to send negative amount in SVD02 element in described above situation.

Response

 While previous RFI #2114 indicated that there is no valid business case to support a negative value in SVD02, additional information on this subject now indicates that there are situations where a negative claim or service line payment amount may be valid.  Situations with pharmacy, vision, and some Medicare examples do include scenarios where negative payment amounts are present; therefore, it would be valid in those situations to have a negative amount in SVD02.

DOCUMENT ID
005010X222