Remark code N106 indicates that reimbursement for services provided to inpatients at a Skilled Nursing Facility (SNF) can only be issued to the SNF itself, except for services that are explicitly excluded from this rule. As a healthcare provider, you should seek payment for these services directly from the SNF rather than billing the patient.
Common causes of code N106 are:
1. Billing Medicare directly for services provided to a patient who is currently an inpatient at a Skilled Nursing Facility (SNF), when Medicare's policy dictates that such payments should be made to the SNF itself.
2. Failure to coordinate with the SNF to ensure that the SNF bills Medicare for the covered services, as SNFs are typically responsible for billing Medicare for services their inpatients receive.
3. Incorrectly classifying a service as excluded from the SNF consolidated billing requirement, leading to a direct claim to Medicare rather than through the SNF.
4. Lack of understanding or oversight regarding the SNF's billing responsibilities, especially for providers who may be new to working with SNF inpatients or unfamiliar with Medicare's billing regulations.
5. Administrative errors in the billing process, such as incorrect patient status or provider number, which can result in Medicare rejecting the claim and issuing code N106.
Ways to mitigate code N106 include establishing a robust verification process to determine a patient's current status with a Skilled Nursing Facility (SNF) before services are rendered. Ensure that your billing staff is trained to recognize services that are billable to the SNF versus those that can be billed to Medicare or other payers directly. Develop a clear communication channel with local SNFs to confirm patient eligibility and service coverage, and create a system to flag services that are likely to be provided to SNF inpatients. Implement a protocol to routinely check the patient's admission and discharge dates in relation to the service date to confirm that billing is directed appropriately. Additionally, maintain accurate and up-to-date records of all services provided to facilitate proper billing and minimize the risk of claim rejections due to incorrect payer submissions.
The steps to address code N106 involve confirming the patient's admission status and the services provided. First, review the patient's chart and billing records to ensure that the services billed were indeed rendered during a period when the patient was an inpatient at a Skilled Nursing Facility (SNF). If the services are among those that can only be billed to the SNF, reach out to the SNF to coordinate billing responsibilities. Ensure that your billing department adjusts the claim to reflect that the SNF is the responsible party for payment. If the services are not exclusive to SNF billing, verify that the claim was coded correctly and resubmit it with the appropriate documentation to support that the services are excluded from consolidated billing and are billable to the payer directly. Establish a clear line of communication with the SNF to prevent future occurrences of this issue.