247Denial Code (CARC)Active
PR 247 Denial Code: Patient Deductible Details
CARC 247 indicates that a deductible applies to a professional service provided in an institutional setting and billed as an institutional claim. This adjustment is specifically for Medicare bundled payments under the Patient Protection and Affordable Care Act (PPACA).
Who Pays: Group Code Liability
For CARC 247, the group code PR is used, meaning the deductible amount is the patient's responsibility. You can bill the patient for this amount.
Why Claims Get Code 247
- A professional service was rendered in a hospital setting and billed on a UB-04 form.
- The patient has a deductible under their Medicare plan that applies to this service.
- The service was part of a Medicare bundled payment plan under PPACA.
- The claim was submitted correctly, but the deductible was not met at the time of service.
How to Fix & Resubmit
- Verify that the service was correctly billed as part of a Medicare bundled payment.
- Check the patient's Medicare deductible status to confirm that it applies to this service.
- Contact the patient to explain the deductible responsibility and arrange for payment.
- Rebill the patient for the deductible amount if it was not collected at the time of service.
Corrected Claim or Appeal?
For CARC 247, neither a corrected claim nor a formal appeal is typically appropriate since it reflects a legitimate deductible under the patient's plan.
Preventing Future 247 Denials
- Verify the patient's deductible status before billing to ensure correct patient responsibility.
- Educate the billing team on identifying services subject to Medicare bundled payments.
- Ensure patient communications clearly explain deductible responsibilities at the time of service.
- Confirm institutional claims are correctly coded for professional services.