Remark code M19 indicates that the claim has been processed but there is an issue with the documentation; specifically, the required oxygen certification or re-certification is missing. This certification is necessary to substantiate the medical necessity and continued use of oxygen therapy for the patient. To resolve this, the healthcare provider must submit the appropriate certification documentation to the payer.
Common causes of code M19 are typically related to issues with the documentation or validity of oxygen therapy certification or re-certification. These may include:
1. The initial certification or re-certification for oxygen therapy was not completed or is missing from the patient's medical records.
2. The submitted certification or re-certification has expired and is no longer valid.
3. The documentation provided does not meet the payer's specific criteria or guidelines for oxygen therapy.
4. There is a lack of physician's narrative or insufficient medical justification to support the need for oxygen therapy.
5. The certification or re-certification was not signed by the appropriate healthcare provider or the signature is missing.
6. The date of the certification or re-certification is incorrect or not within the required timeframe.
7. The claim was submitted without the necessary accompanying documentation, such as test results supporting the need for oxygen.
8. There may be discrepancies between the dates of service billed and the dates covered by the certification or re-certification.
Addressing these issues promptly can help ensure that claims are processed correctly and that reimbursement is not delayed or denied.
Ways to mitigate code M19 include implementing a robust tracking system for oxygen therapy patients to ensure timely certification and re-certification. Establish a protocol for regular review of patient records to verify that oxygen certification is current and aligns with the prescribed therapy duration. Educate staff on the importance of obtaining and documenting oxygen certification before billing, and consider automated reminders to alert when certifications are nearing expiration. Regularly audit billing and documentation processes to identify and address any gaps that could lead to missing certifications.
The steps to address code M19 involve first verifying whether the oxygen certification or re-certification documentation was originally obtained and is on file. If the documentation is missing, reach out to the prescribing physician to obtain the necessary certification. Ensure that the certification includes all required information, such as the patient's oxygen saturation level, the flow rate, and duration of oxygen use. Once the certification is acquired, resubmit the claim with the appropriate documentation attached. If the documentation was previously submitted, review the submission to ensure it was sent to the correct location and that it included all pertinent information. If an error in the submission process is identified, correct it and resubmit the claim. Keep a record of all communications and submissions in case further follow-up with the payer is needed.