Remark code M39 is an alert indicating that the patient is not responsible for payment for the service because the advance notice of non-coverage given to the patient did not meet the specific program requirements. This means that the healthcare provider must adhere to proper notification protocols to hold the patient financially accountable, and failure to do so results in the provider being unable to charge the patient for the service in question.
Common causes of code M39 are:
1. Incomplete or incorrect Advance Beneficiary Notice of Noncoverage (ABN) forms provided to the patient.
2. Failure to deliver the ABN to the patient within the required timeframe.
3. Lack of proper signatures on the ABN, either from the provider or the patient.
4. Providing an ABN for services that are covered and not typically requiring an ABN, leading to confusion about patient liability.
5. Use of outdated or obsolete ABN forms that do not meet current regulatory standards.
6. Insufficient documentation to support the necessity of the ABN or the reason for the belief that Medicare may not cover the service.
7. Errors in the language or content of the ABN that make it non-compliant, such as not clearly explaining the reason Medicare may deny payment.
8. Not properly informing the patient of their rights and potential financial liability as outlined in the ABN.
9. ABN not being specific enough about the particular service or item that is not expected to be covered by Medicare.
10. Failure to ensure that the patient fully understands the ABN, including any implications of refusing the service or the potential costs involved.
Ways to mitigate code M39 include ensuring that all Advance Beneficiary Notices (ABNs) are completed correctly and in compliance with the specific program requirements. Staff should be thoroughly trained on when and how to issue ABNs, making sure that the notices are provided to patients before the delivery of services that are likely to be deemed not medically necessary. It's also important to regularly review and update the ABN forms to reflect any changes in program requirements. Additionally, implementing a robust documentation system can help track the issuance of ABNs and provide proof of compliance in case of audits. Regular audits of ABN processes within your practice can also help identify and correct any compliance issues proactively.
The steps to address code M39 involve a thorough review of the advance notice of non-coverage that was provided to the patient. First, ensure that the notice was given within the required timeframe and includes all necessary information as per the program guidelines. If any discrepancies are found, correct the documentation and resubmit the claim with the appropriate notice attached. If the notice was compliant, gather evidence of compliance, such as signed acknowledgments from the patient, and submit an appeal to the payer with the supporting documentation. Additionally, review your internal processes and staff training to prevent future occurrences of non-compliant notices.