Remark code N107 indicates that services provided to patients who are inpatients at a Skilled Nursing Facility (SNF) must be included on the inpatient claim form. These services are not to be billed independently as outpatient services.
Common causes of code N107 are:
1. Billing for outpatient services that were actually provided to a patient during an inpatient stay at a Skilled Nursing Facility (SNF).
2. Incorrectly classifying inpatient SNF services as outpatient on the claim form.
3. Failure to include the services on the SNF's consolidated billing (CB) as required by Medicare.
4. Lack of coordination between the SNF and external providers, leading to separate billing for services that should be included in the SNF's inpatient claim.
5. Misunderstanding of Medicare billing rules for SNF inpatients, resulting in improper claim submission.
6. Inadequate documentation or coding errors that fail to reflect the patient's inpatient status at the SNF.
7. System or processing errors that cause outpatient service codes to be applied to inpatient SNF services.
Ways to mitigate code N107 include ensuring that all services provided to patients within a Skilled Nursing Facility (SNF) are included on the inpatient claim form. It's important to have a robust verification process in place to confirm the patient's admission status before billing. Staff should be trained to recognize which services are covered under the consolidated billing requirements for SNF inpatients and to consolidate all charges appropriately. Additionally, implementing a system that flags services rendered to SNF inpatients can help prevent the submission of separate outpatient claims for those services. Regular audits of billing practices can also help identify and correct any issues that could lead to this code being generated.
The steps to address code N107 involve reviewing the patient's admission status to confirm that they are indeed an inpatient at a Skilled Nursing Facility (SNF). If the services were incorrectly billed as outpatient, reprocess the claim by including the services on the inpatient claim form. Ensure that all services provided are accurately documented and that the billing reflects the inpatient status. If the services were correctly billed and this code appears in error, gather supporting documentation and submit an appeal to the payer with a clear explanation and evidence that the services were part of the inpatient care. It's also important to communicate with the SNF to verify that their records match the billing records and to prevent future occurrences of this issue.