What is a remittance advice (RA) in CMS?

• A. A document detailing payment, adjustments, and reasons for denial or partial payment of a claim.
• B. A pre-authorization notification.
• C. A summary of patient history.
• D. A claim submission form.

Answer: (A)

A remittance advice in CMS is the document that explains how a claim was processed and paid. It details the payment amount issued, any adjustments made (such as write-offs or other contractual adjustments), and the reasons for denial or partial payment. It may also show any patient responsibility like deductible or coinsurance. This helps providers reconcile their accounts and understand exactly what the payer approved, what was denied, and why, often using standard reason codes (CARCs and RARCs) and, in electronic form, the 835 remittance advice.

This is not a pre-authorization notification, which is about obtaining approval before a service is provided. It’s also not a summary of patient history or a claim submission form, which relate to different parts of the claims lifecycle.