Remark code M6 indicates that as a provider, you are required to supply and maintain the specified item for any duration in which the patient has a medical necessity for it, throughout the remaining reasonable useful life of the equipment. This means that you are responsible for ensuring the patient has access to functioning equipment and any necessary servicing for as long as it is medically needed, up until the point where the equipment is no longer considered to have a reasonable useful life.
Common causes of code M6 are:
1. The healthcare provider did not indicate that the durable medical equipment (DME) previously provided to the patient is still medically necessary.
2. There is a lack of documentation or insufficient documentation to support the continued need for the equipment.
3. The equipment has reached the end of its reasonable useful lifetime, but the provider has not confirmed this or provided evidence to the contrary.
4. The claim was submitted without the required certification or recertification that the DME is still needed for the patient's medical condition.
5. The patient's medical records do not reflect an ongoing assessment of the need for the equipment.
6. The provider has not adequately communicated with the payer regarding the patient's current medical condition and the necessity for the continued use of the equipment.
Ways to mitigate code M6 include implementing a robust tracking system for durable medical equipment (DME) that records the delivery, setup, and servicing dates. Ensure that your staff is trained to understand the reasonable useful lifetime of each piece of equipment and to communicate effectively with patients about their responsibilities. Regularly review and update your inventory management practices to ensure that all equipment is maintained according to the manufacturer's recommendations and is in good working condition. Establish a proactive outreach program to schedule maintenance or replacement services before the end of the equipment's lifetime. Additionally, maintain thorough documentation of all services provided to facilitate audits and demonstrate compliance with the equipment's servicing requirements.
The steps to address code M6 involve verifying the duration of the medical need for the equipment in question. First, review the patient's medical records to confirm the necessity and prescribed duration of the equipment use. Ensure that the documentation clearly supports ongoing need as per the physician's orders.
Next, check the equipment's reasonable useful lifetime against the manufacturer's guidelines and compare it to the duration of the patient's need. If the equipment is still within its useful lifetime and the patient's need is ongoing, continue to provide the equipment and document the service dates and medical necessity in the patient's file.
If the equipment's lifetime has expired or the patient no longer requires it, take steps to discontinue the service and update the patient's records accordingly. Communicate with the patient and their healthcare provider to ensure a clear understanding of the equipment's status and the patient's ongoing needs.
Lastly, resubmit the claim with the appropriate documentation to support the continued medical need or the discontinuation of the equipment service.