Remark code MA94 indicates that the claim was processed without the necessary statement 'Attending physician not hospice employee' on the claim form, which is required to certify that the physician providing care is not an employee of the hospice agency. This omission may affect claim adjudication and should be corrected for proper processing.
Common causes of code MA94 are typically related to errors or omissions in the claim submission process for hospice services. These may include:
- Inaccurate completion of the claim form where the provider fails to indicate that the attending physician is not an employee of the hospice agency.
- Oversight by the billing staff in not checking the appropriate box or entering the required statement that certifies the attending physician's non-employment status with the hospice.
- Misunderstanding of the hospice billing requirements, leading to the incorrect assumption that the employment status of the physician does not need to be explicitly stated.
- Lack of proper training or updates on hospice billing regulations, resulting in the omission of necessary certifications on the claim.
- Inadequate claim review processes that fail to catch the missing statement before the claim is submitted to the payer.
- Systematic errors within the electronic health record (EHR) or billing software that do not prompt or allow for the correct information to be entered on the hospice claim.
- Communication breakdowns between the hospice provider and the attending physician's office, leading to a lack of clarity about the employment relationship that should be reflected on the claim.
Ways to mitigate code MA94 include ensuring that the billing staff is thoroughly trained on the specific documentation requirements for hospice claims. This includes the necessity of including the statement 'Attending physician not hospice employee' on the claim form. It's important to establish a checklist for hospice claim submissions that includes this certification as a mandatory item. Regular audits of hospice claims can also help identify if this statement is being consistently omitted, allowing for corrective action to be taken before claims are submitted. Additionally, implementing a robust claim scrubbing software that flags missing statements or certifications can prevent this error. It's also beneficial to maintain open communication with attending physicians to confirm their employment status and document it appropriately in the patient's record and on the claim form.
The steps to address code MA94 involve reviewing the claim form to ensure that the statement 'Attending physician not hospice employee' is clearly entered as required. If the statement is missing, amend the claim form to include it. This statement is a certification that the rendering physician is not an employee of the hospice, which is necessary for certain billing situations. Once the statement is added, resubmit the claim to the payer for processing. It's also advisable to check your billing system and processes to ensure that this certification is included on all future claims where applicable to avoid this issue recurring.