DENIAL CODES

Denial code M96

Remark code M96 indicates that only inpatient facilities can bill for technical service components; providers should bill for professional components only.

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What is Denial Code M96

Remark code M96 indicates that the technical component of a service provided to an inpatient can only be billed by the facility where the patient was admitted. The entity billing for the service must reach out to the inpatient facility to receive payment for the technical component. If the billing party has not yet billed for the service, they should only submit a claim for the professional component of the service to the insurer.

Common Causes of RARC M96

Common causes of code M96 are:

1. The billing entity incorrectly billed for the technical component of a service that was provided to a patient during an inpatient stay, which should be billed solely by the inpatient facility.

2. There may have been a misunderstanding or lack of clarity about the division of billing responsibilities between the professional and technical components of the service provided.

3. The claim was submitted without proper coordination with the inpatient facility, leading to a duplication of billing efforts for the technical component.

4. The billing party may not have been aware that the patient was admitted as an inpatient at the time the service was rendered, resulting in an inappropriate claim for the technical component.

5. There could be an error in the billing system or process that automatically billed for both the professional and technical components without recognizing the inpatient status of the patient.

6. The claim may have been submitted with incorrect or incomplete information, failing to indicate that the technical component is included in the inpatient facility's charges.

Ways to Mitigate Denial Code M96

Ways to mitigate code M96 include ensuring that billing for technical components of services provided to inpatients is done directly by the inpatient facility. To avoid this remark code, review the place of service and the components included in the billing to confirm that only the professional component is billed when services are rendered by an external provider. Establish a clear communication channel with the inpatient facility to coordinate on who is responsible for billing each component of the service. Additionally, implement a verification process in your revenue cycle management system to automatically flag claims that include technical components for inpatients, prompting a review before submission. This will help ensure that claims are compliant with the requirements and that the inpatient facility is handling the technical component appropriately.

How to Address Denial Code M96

The steps to address code M96 involve reviewing the claim to ensure that it accurately reflects the services provided. If the technical component was incorrectly billed separately, it should be removed from the claim. The billing team should then revise the claim to include only the professional component for the services rendered. If the professional component has not yet been billed, a new claim should be prepared and submitted for this portion of the service only. It is also essential to communicate with the inpatient facility to confirm that they have billed, or will bill, for the technical component to prevent any duplication of billing. After making the necessary adjustments, resubmit the claim with the correct information to the payer for processing.

CARCs Associated to RARC M96

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