Remark code MA117 indicates that the claim has been assessed a $1.00 user fee. This fee is typically applied per claim submission and is deducted from the reimbursement amount by the payer. Healthcare providers should account for this deduction in their financial records and adjust their patient billing statements accordingly.
Common causes of code MA117 are:
1. The claim was submitted to Medicare, and the $1.00 user fee was automatically assessed as part of the Medicare Secondary Payer (MSP) process.
2. The provider may have billed for services related to liability insurance (including self-insurance), no-fault insurance, or workers' compensation, which requires the application of the user fee.
3. The fee could be associated with the cost of processing the claim when Medicare is not the primary payer and the claim needs to be coordinated with another payer.
4. The user fee might be applied due to the submission of a claim for conditional payment, where Medicare pays first awaiting reimbursement from the primary payer.
5. The charge could be a standard administrative fee that is applied to claims involving certain types of insurance coverage as mandated by the Medicare Secondary Payer rules and regulations.
Ways to mitigate code MA117 include reviewing the payer's policy on administrative fees to understand the circumstances under which a user fee is applied. Ensure that your billing staff is aware of these fees and incorporates them into the cost estimates provided to patients prior to service delivery. Regularly update your billing software and fee schedules to automatically account for these fees during the claims submission process. Additionally, consider negotiating with the payer to see if these fees can be waived or reduced for your healthcare organization.
The steps to address code MA117 involve reviewing the claim to confirm the accuracy of the fee applied. If the fee is correct, adjust the patient's account to reflect the user fee and ensure that the billing system is updated to account for this charge in future claims. If the fee is not accurate or should not have been applied, contact the payer to dispute the charge and request a reevaluation of the claim. Document all communications and adjustments made in relation to this code for accurate record-keeping and compliance.