Remark code M42 indicates that the claim submitted requires a medical necessity form to be completed and personally signed by the attending physician in order to be considered for payment. This signature is necessary to validate that the services provided were medically necessary for the patient's condition. Without this signed form, the claim may be denied or delayed.
Common causes of code M42 are:
1. The attending physician's signature is missing on the medical necessity form.
2. The signature on the medical necessity form is not original (e.g., stamped, photocopied, or electronic when a handwritten signature is required).
3. The form was signed by a different healthcare provider, not the attending physician who is directly responsible for the patient's care.
4. The signature is illegible or does not match the attending physician's name on record.
5. The medical necessity form was not signed within the required timeframe, making it invalid at the time of the claim submission.
6. Documentation supporting the medical necessity of the service or procedure is incomplete or missing, even though the form is signed.
7. The medical necessity form is not the correct or updated version required by the payer.
8. There is a discrepancy between the date of service and the date the medical necessity form was signed, raising questions about the validity of the signature.
Ways to mitigate code M42 include implementing a thorough review process to ensure that all medical necessity forms are signed by the attending physician before submission. Establishing a checklist for the billing staff to verify signatures and training physicians on the importance of timely and personal signing of these forms can also help prevent this issue. Additionally, utilizing electronic health record (EHR) systems with integrated alerts for unsigned documents can streamline the process and reduce the likelihood of receiving code M42. Regular audits of billing procedures can further ensure compliance and prompt correction of any oversights related to physician signatures on medical necessity forms.
The steps to address code M42 involve ensuring that the attending physician personally signs the medical necessity form. Begin by reviewing the patient's documentation to confirm that the form is on file. If the form is missing or unsigned, reach out to the attending physician's office to obtain the necessary signature. Provide clear instructions on the urgency and importance of the signature for billing purposes. Once the signed form is received, resubmit the claim with the appropriate documentation attached. Keep a copy of the signed form in the patient's record for future reference and to prevent similar issues with subsequent claims.