CARC · PR group
PR-2
Coinsurance amount
Patient responsibility; billable to the patient
- What it means
- The patient's percentage share of the allowed amount.
- Likely cause
- Normal adjudication on plans with coinsurance rather than a flat copay.
- How to fix it
- Quote coinsurance from the allowed amount, not the billed charge, and bill the patient promptly after the 835 posts.
- Revenue impact
- Collectible; aging PR balances are the second-largest leak after unworked denials.
- patient responsibility
- coinsurance
- collections
Related codes
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