Remark code MA28 indicates that the notice received by a physician or supplier who did not accept assignment is solely for informational purposes and does not involve them in the decision-making process. Furthermore, this notice does not grant any additional appeal rights beyond those already established by existing regulations or instructions.
Common causes of code MA28 are:
1. The physician or supplier submitted a claim for a Medicare patient but did not accept assignment, meaning they did not agree to accept the Medicare-approved amount as full payment for covered services.
2. The claim was processed and a determination was made regarding payment, but since the physician or supplier did not accept assignment, they are not considered a party to the determination.
3. The physician or supplier is being notified of the payment determination for informational purposes only, which implies that they may not have the same appeal rights as those who accept assignment.
4. There may have been a misunderstanding or error in the submission process where the physician or supplier inadvertently indicated non-acceptance of assignment.
5. The notice serves as a reminder to the physician or supplier that by not accepting assignment, they limit their involvement in the Medicare claims appeal process.
Ways to mitigate code MA28 include implementing thorough checks to ensure that claims are submitted with the correct assignment status. This involves verifying whether the physician or supplier has accepted assignment on the services billed before submitting the claim. It's also essential to educate billing staff on the implications of accepting or not accepting assignment and to keep updated records of each physician's or supplier's assignment status to prevent confusion. Regular training on Medicare regulations and proper claim submission processes can also help reduce the occurrence of this remark code. Additionally, setting up a system to track notices and determinations can help in understanding patterns that may lead to receiving code MA28, allowing for proactive measures to avoid it in the future.
The steps to address code MA28 involve reviewing the claim to ensure that it was submitted correctly and acknowledging that, as a non-participating provider who did not accept assignment, the notice serves solely as an informational alert. It's important to verify that the services provided were accurately documented and billed, and that the patient's insurance information was up-to-date and correctly processed. Since no additional appeal rights are granted with this notice, focus on educating the patient about their responsibility for payment and consider internal processes to prevent future occurrences, such as verifying assignment acceptance prior to service delivery. If there are recurring issues with assignment acceptance, it may be beneficial to reassess the practice's policy on accepting assignment to streamline the revenue cycle.