Remark code MA118 is an alert indicating that Medicare has not issued payment for the claim because the services or supplies were provided to a Medicare-eligible veteran through a Department of Veterans Affairs (VA) facility. It also signifies that coinsurance and/or deductible amounts may still be applicable to the claim.
Common causes of code MA118 are:
1. The services or supplies were provided to a veteran who is eligible for Medicare, but the services were furnished through a Department of Veterans Affairs (VA) facility, which is typically not covered by Medicare.
2. The claim was submitted to Medicare instead of being directed to the VA for payment, as the VA is the primary payer for services rendered in their facilities to eligible veterans.
3. There may have been an error in the billing process where the provider mistakenly billed Medicare rather than the VA.
4. The provider may not have been aware of the patient's veteran status or the fact that the services were provided through a VA facility, leading to an incorrect payer being billed.
5. The claim may lack necessary documentation or proper coding indicating that the services should be covered by the VA, resulting in Medicare denying the payment.
6. The patient may have dual eligibility for both Medicare and VA benefits, and there was a coordination of benefits issue that led to Medicare denying the claim while awaiting determination of the primary payer.
Ways to mitigate code MA118 include ensuring that the billing staff is aware of the patient's veteran status and the associated Medicare eligibility. Prior to submitting claims, verify if the services were provided through a Department of Veterans Affairs (VA) facility. If so, coordinate with the VA to understand the coverage responsibilities. Additionally, implement a process to check the patient's insurance coverage and benefits for each visit, and educate the patient about their responsibility for coinsurance and/or deductible when receiving services outside of the VA system. Establish a clear communication channel with the VA to confirm which services are covered and to prevent billing Medicare inappropriately for services provided by the VA.
The steps to address code MA118 involve several actions to ensure proper billing and reimbursement. First, verify the patient's eligibility and confirm that the services were indeed provided through a Department of Veterans Affairs (VA) facility. Next, review the Explanation of Benefits (EOB) to determine the amount of coinsurance and/or deductible that is the patient's responsibility.
Subsequently, re-bill the patient or the responsible party for the coinsurance and/or deductible amounts, ensuring that the billing statements clearly indicate these charges are due to services received through a VA facility. It's also important to check if there are any secondary payers that could cover these costs and, if so, coordinate benefits accordingly.
If the services were not provided through a VA facility, or if there is an error in the claim, correct the billing information and resubmit the claim to Medicare with the appropriate documentation. Lastly, document all actions taken in the patient's account for future reference and to maintain a clear audit trail.