DENIAL CODES

Denial code M114

Remark code M114 indicates a service was aligned with DMEPOS Competitive Bidding rules. Contact your contractor for project details.

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What is Denial Code M114

Remark code M114 indicates that the service billed was adjudicated following the rules and guidelines of the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program or a Demonstration Project. Providers seeking further details or clarification on these specific projects should reach out to their local Medicare contractor.

Common Causes of RARC M114

Common causes of code M114 are:

1. The healthcare provider submitted a claim for a Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) item or service that is subject to the Competitive Bidding Program, and the claim did not meet the established program requirements.

2. The item or service was provided by a supplier that is not contracted with the Medicare Competitive Bidding Program for the specific competitive bidding area where the service was rendered.

3. The claim was submitted for a DMEPOS item that is part of a Demonstration Project, and the provider did not adhere to the specific guidelines or billing procedures required for that project.

4. The healthcare provider may have used a billing code that is not recognized under the Competitive Bidding Program or the Demonstration Project, resulting in a processing issue with the claim.

5. The claim may have been submitted without the necessary documentation or authorization that is required under the Competitive Bidding Program or Demonstration Project rules.

6. The beneficiary receiving the DMEPOS item may not be eligible under the terms of the Competitive Bidding Program or the Demonstration Project, leading to a denial or adjustment of the claim.

Ways to Mitigate Denial Code M114

Ways to mitigate code M114 include ensuring that your billing team is well-versed in the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program requirements. Regular training sessions should be conducted to keep staff updated on any changes in the program.

Additionally, it's crucial to verify that the equipment being billed is sourced from a Medicare-approved supplier that has won a bid under the competitive bidding program. Before submitting claims, double-check that all documentation aligns with the specific guidelines of the DMEPOS Competitive Bidding Program, including proper coding and pricing.

Implementing a robust pre-claim review process can help catch any discrepancies that could lead to this remark code. It's also beneficial to have a system in place for regular audits of DMEPOS claims to ensure ongoing compliance with the program's rules.

How to Address Denial Code M114

The steps to address code M114 involve verifying the details of the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program or the specific Demonstration Project under which the service was billed. Review the claim to ensure that the billed items are included in the competitive bidding program and that the supplier is an approved contract supplier for the competitive bidding area where the service was provided. If the supplier is not approved, you may need to rebill the service with a supplier who is part of the program. Additionally, confirm that all documentation, including medical necessity and any required authorizations, is accurate and complete. If there are discrepancies, correct the claim accordingly and resubmit. If the claim appears to be in order, but the code persists, consider reaching out to the local contractor for further clarification on the specific rules and guidelines that may have affected the processing of the claim.

CARCs Associated to RARC M114

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