Remark code M86 is an indication that the submitted service has been denied because a payment has already been made for a same or similar procedure within a predetermined time frame. This suggests that the claim may be considered a duplicate, and reimbursement for this service will not be provided as it appears to overlap with a previous payment. It is important to review the patient's claim history and the payer's guidelines to understand the specific time frame referenced and to ensure accurate billing and coding practices to prevent such denials.
Ways to mitigate code M86 include implementing a robust tracking system for patient services to ensure that claims for the same or similar procedures are not submitted within the payer's specified time frame. Regularly updating and reviewing the schedule of procedures and their respective time frames can help prevent duplicate claims. Additionally, training billing staff to recognize and flag potential duplicates before submission, and using claim scrubbing software that checks for such issues, can also reduce the likelihood of receiving an M86 denial. It's important to maintain clear communication with clinical staff to verify that the services rendered are accurately documented and coded, and to confirm that any subsequent procedures are not considered duplicates by the payer. If a procedure is repeated within the time frame due to medical necessity, ensure that proper documentation and justification are provided to support the claim.
The steps to address code M86 involve a thorough review of the patient's billing records to confirm whether the reported service was indeed previously billed and paid. If a duplicate payment has occurred, no further action is necessary. However, if the service was not previously billed or paid, or if it was billed under a different date of service or provider, gather all relevant documentation, including dates of service, procedure codes, and payment records. Then, submit a written appeal to the payer with this evidence to clarify the discrepancy and request a reevaluation of the claim. Ensure that the appeal is detailed, highlighting the unique aspects of the service provided and why it is distinct from the service previously billed. If the denial was due to an error on the payer's side, politely request correction and reprocessing of the claim. Keep a record of all communications for future reference.