Remark code M32 indicates that the payment made is conditional, as it is subject to change based on the decision of the patient's primary insurance payer. This payment may need to be refunded if additional payment is received from another payer for the same service. It is the provider's responsibility to inform the office without delay if any further payment is obtained for this service.
Common causes of code M32 are:
1. The patient has multiple insurance policies, and the secondary payer has made a payment while awaiting the primary payer's decision.
2. There is a coordination of benefits issue where the primary insurance has not yet determined their payment responsibility, leading the secondary payer to issue a conditional payment.
3. The service in question is under review by the primary payer for coverage determination, and the secondary payer has issued a payment to the provider in the interim.
4. The claim was submitted to the secondary insurance before the primary insurance completed processing, resulting in a provisional payment that may need to be refunded if the primary insurance covers the service.
5. The secondary payer has made a payment based on an assumption of coverage, but there is still pending verification of the primary payer's coverage or denial of the service.
6. The patient's coverage details are unclear or have recently changed, causing the secondary payer to issue a payment until the primary payer's responsibility is clarified.
Ways to mitigate code M32 include implementing a robust tracking system for conditional payments and primary payer decisions. Ensure that your billing staff is trained to recognize and respond to conditional payments, and establish a protocol for monitoring the status of primary insurance claims. Regularly review cases with conditional payments and follow up with the primary payer to determine the claim's status. Additionally, set up alerts to notify your team when additional payments are received, so that refunds can be processed in a timely manner if necessary. It's also beneficial to maintain clear communication with the payer's office to promptly address any additional payment situations.
The steps to address code M32 involve a few key actions to ensure compliance and proper revenue cycle management. First, review the patient's account to confirm the conditional payment and note the amount.
Next, monitor the account for any additional payments from the primary payer. If another payment is received, calculate the difference, if any, between the conditional payment and the new payment to determine if a refund is necessary.
Then, contact the office as instructed in the remark code to report the additional payment. Provide all necessary documentation, including the date and amount of the additional payment, to facilitate any required adjustments.
Finally, update the patient's account accordingly and adjust the balance if a refund is issued. It's essential to maintain clear and accurate records of all communications and transactions related to this code for compliance and auditing purposes.