DENIAL CODES

Denial code M9

Remark code M9 indicates the tenth rental month for equipment, prompting providers to offer patients a purchase option.

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What is Denial Code M9

Remark code M9 indicates: Alert: This is the tenth rental month. You must offer the patient the choice of changing the rental to a purchase agreement.

Common Causes of RARC M9

Common causes of code M9 are:

1. The healthcare provider has not communicated the option to purchase the rented medical equipment to the patient after the rental period has reached a certain threshold, typically around the tenth month.

2. There is a lack of proper documentation or notification in the patient's file indicating that the patient has been informed of their right to purchase the equipment.

3. The billing system may not be updated or configured to automatically trigger the transition from rental to purchase after the designated rental period.

4. The healthcare provider may have failed to modify the billing code from rental to purchase on the claim form after the patient has chosen to purchase the equipment.

5. There might be an oversight in the revenue cycle management process where the staff responsible for managing equipment rentals has not followed up with the patient regarding the purchase option.

6. The patient may have been incorrectly billed for continued rental beyond the period where a purchase option should have been offered, indicating a breakdown in the rental agreement tracking within the RCM system.

Ways to Mitigate Denial Code M9

Ways to mitigate code M9 include implementing a robust tracking system for rental equipment that alerts your billing department as the rental period approaches its tenth month. Ensure that your staff is trained to proactively reach out to patients with the option to convert their rental into a purchase agreement well before this time frame. Additionally, maintain clear communication channels with patients to educate them about their options regarding equipment rental and purchase, and document all interactions and decisions to ensure compliance and accurate billing.

How to Address Denial Code M9

The steps to address code M9 involve initiating a conversation with the patient regarding their rental equipment. The healthcare provider's billing department should review the patient's account to confirm that the tenth rental month is approaching or has been reached. Next, the provider should contact the patient to inform them of their right to convert the rental into a purchase agreement. This communication should clearly outline the benefits and implications of switching to a purchase, including any changes in cost-sharing, warranty information, and the impact on insurance coverage.

The billing team should prepare the necessary paperwork to facilitate the change if the patient opts to purchase the equipment. This may include a new contract or agreement and an updated claim submission to the insurance company reflecting the change in billing from rental to purchase. It's also important to document the patient's decision and the notification process in their account to ensure compliance and for future reference.

If the patient decides to continue renting the equipment, the provider should note this in the patient's record and continue to bill for the rental as per usual. Regular follow-ups may be necessary to ensure the patient is aware of their options going forward.

CARCs Associated to RARC M9

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