Remark code M73 indicates that the Health Professional Shortage Area (HPSA) or Physician Scarcity Bonus payment is applicable only to the professional part of the service provided. To correctly process this claim for the bonus, the healthcare provider must separate the billing into professional and technical components and resubmit them accordingly.
Common causes of code M73 are typically related to billing errors where services provided in Health Professional Shortage Areas (HPSAs) are not correctly split into their professional and technical components. Specifically, this might occur when:
1. The billing staff inadvertently submits a global bill for a service that includes both the professional and technical components together, rather than itemizing them separately.
2. There is a misunderstanding of the billing requirements for services performed in HPSAs, leading to incorrect claim submission.
3. The billing system is not properly configured to automatically separate the professional and technical components for services eligible for the HPSA bonus.
4. There is a lack of proper training or updates for coding staff on the specific billing practices required for HPSA-related services.
5. Manual entry errors occur, where the individual processing the claim fails to apply the correct modifiers or separate the components as required by Medicare guidelines.
Ways to mitigate code M73 include ensuring that claims for services provided in Health Professional Shortage Areas (HPSAs) or areas with Physician Scarcity are billed with the appropriate modifiers to distinguish between the professional and technical components. It is essential to train billing staff to recognize services that are subject to this bonus and to use a billing system that can automatically split the claim into separate components when required. Regularly reviewing the latest guidelines on HPSA/Physician Scarcity bonus payments and conducting internal audits can help identify and correct any issues with how these services are billed before they are submitted to prevent this remark code from occurring.
The steps to address code M73 involve reviewing the original billing submission to ensure that the professional and technical components of the service were billed separately. If they were not, the provider should adjust the billing to split the service into two distinct claims: one for the professional component, which includes the work performed by the healthcare provider, and another for the technical component, which covers the use of equipment and facilities.
The professional component should be billed with the appropriate modifier to indicate that it is eligible for the Health Professional Shortage Area (HPSA) or Physician Scarcity bonus. Once the claims have been correctly separated and modified, they should be resubmitted for processing.
It is also important to verify that the service provided is indeed eligible for the bonus and that the provider is practicing within a designated HPSA or area of physician scarcity.