Remark code M36 indicates that the claim has reached the 11th rental month for the durable medical equipment, and the payer requires confirmation that the patient has been offered the option to purchase the equipment before further rental claims can be reimbursed.
Common causes of code M36 are typically related to the rental of durable medical equipment (DME) where the healthcare provider has not properly documented or communicated the option for the patient to purchase the rented equipment. This can occur if:
1. The provider failed to inform the patient of their right to purchase the equipment after a certain rental period.
2. There is a lack of documentation indicating that the patient was given the option to convert the rental to a purchase.
3. The provider did not update the billing system to reflect that the patient has been given the option to purchase the equipment, leading to a discrepancy in the claim.
4. The patient was not given the choice to purchase due to an oversight or miscommunication within the provider's administrative process.
5. The billing department prematurely billed for continued rental without verifying the patient's intent or eligibility to purchase the equipment.
6. There is a misunderstanding of the payer's requirements for converting the rental to a purchase, resulting in non-compliance with the payer's guidelines.
It is important for healthcare providers to establish clear protocols and maintain thorough communication with patients regarding their options for DME to avoid this issue.
Ways to mitigate code M36 include ensuring that your billing system tracks the duration of equipment rentals and alerts you before the 11th rental month. Implement a process to contact patients in a timely manner, well before the 11th month, to discuss the option of converting their rental into a purchase. Document this communication and the patient's decision in their record. If the patient opts to purchase, update the billing information to reflect the change from rental to purchase and submit the claim with the appropriate documentation to support the conversion. Regularly train staff on the importance of monitoring rental periods and the procedures for converting rentals to purchases to prevent this issue from occurring.
The steps to address code M36 involve confirming the patient's rental-to-purchase option. First, review the patient's rental agreement and history to ensure that they are indeed in the 11th rental month. Next, communicate with the patient to confirm they have been informed of their option to purchase the equipment. Document this communication thoroughly. If the patient elects to convert the rental to a purchase, update the billing records to reflect this choice and resubmit the claim with the appropriate documentation and modifiers indicating the change in billing status from rental to purchase. If the patient chooses to continue renting, ensure that this decision is also well-documented and include a statement or attestation with the resubmitted claim that the patient has been given the option to purchase but has elected to continue renting. It's crucial to maintain clear and timely communication with both the patient and the payer throughout this process to facilitate the resolution of the claim.