Remark code M2 indicates that the service billed was not paid separately because it was provided during a period when the patient was admitted as an inpatient. This suggests that the cost of the service is included in the inpatient payment or bundle and is not eligible for separate reimbursement.
Common causes of code M2 are:
1. The billed service is included in the payment/allowance for another service or procedure that has already been adjudicated.
2. The service was provided during an inpatient stay, and the cost of the service is covered under the inpatient prospective payment system (IPPS) or another global payment arrangement.
3. The procedure or service is considered part of the inpatient care and is not billable or payable separately according to the terms of the payer's inpatient reimbursement policy.
4. The claim was submitted for a service that is typically bundled into the inpatient payment, such as certain medications, supplies, or ancillary services.
5. There may have been an error in coding or billing where outpatient services were incorrectly coded as separate when they should have been included in the inpatient claim.
6. The provider may have failed to properly document the medical necessity of the service as separate and distinct from the inpatient stay, leading to the denial of separate payment.
Ways to mitigate code M2 include ensuring that billing staff are aware of the patient's admission status and coordinating with the inpatient facility to confirm which services are included in the inpatient payment bundle. It's important to review the patient's chart and the payer's inpatient coverage policies to determine if the service being billed can be separately reimbursed or if it is considered part of the inpatient care package. Additionally, implementing a system to flag services typically bundled during inpatient stays can help prevent inadvertent separate billing of these services. Training staff to recognize and correctly code inpatient versus outpatient procedures will also reduce the likelihood of receiving an M2 denial. Regular audits of billing practices can help identify patterns that lead to M2 denials, allowing for corrective action to be taken.
The steps to address code M2 involve reviewing the patient's admission status to confirm that the service billed was indeed provided during an inpatient stay. If the service was incorrectly billed as inpatient, resubmit the claim with the correct patient status. If the service was part of the inpatient stay, check if it can be bundled into the inpatient claim. If it's a separately billable service, ensure proper documentation and justification are provided to support the separate billing, and then resubmit the claim with the necessary evidence. If the denial is correct, adjust the billing records to reflect the non-payment and inform the appropriate department to prevent future occurrences.