Denial code N114

Remark code N114 indicates payment is based on the lesser of a blended rate or submitted charge for ambulance services during fee schedule transition.

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What is Denial Code N114

Remark code N114 is an indication that, for the service billed, payment has been made based on a transitional blended rate under the Ambulance Fee Schedule. This blended rate is derived from a combination of a percentage of the reasonable charge or cost and the fee schedule amounts. The actual payment is the lesser of this calculated blended amount or the submitted charge for the service. Providers will receive annual notifications detailing the specific percentages used for the blended payment calculation.

Common Causes of RARC N114

Common causes of code N114 are incorrect or outdated fee schedule amounts being used in the billing process, submission of charges that do not align with the current year's blended payment calculation percentages, or failure to update billing systems with the latest notification regarding the yearly percentages for the blended payment calculation. Additionally, this code may be triggered if there is a discrepancy between the reasonable charge/cost and the fee schedule amounts, leading to an adjustment where payment is made based on the lesser amount.

Ways to Mitigate Denial Code N114

Ways to mitigate code N114 include ensuring that your billing team is up-to-date with the latest Ambulance Fee Schedule and understands the blended payment calculation method. Regular training sessions should be conducted to keep staff informed about the annual changes in the percentages used for the blended payment calculation. Additionally, implementing a robust charge capture process that accurately reflects the services provided can help prevent discrepancies between the submitted charges and the fee schedule amounts. It's also beneficial to have a system in place to regularly review and reconcile the charges submitted with the allowable fee schedule to ensure that claims are within the expected payment thresholds. Regular audits of ambulance service claims can also help identify and correct any issues proactively before they result in remark code N114.

How to Address Denial Code N114

The steps to address code N114 involve a multi-faceted approach to ensure proper reimbursement for ambulance services during the transition to the Ambulance Fee Schedule. First, review the current year's notification to understand the specific percentages applied to the blended payment calculation. Next, audit the claim in question to verify that the charges submitted align with the lesser of the blended rate or the actual submitted charges. If discrepancies are found, adjust the billing records accordingly.

Additionally, ensure that your billing software or process is updated to reflect the current year's blended rate calculations. If the claim has been denied or underpaid, prepare and submit a corrected claim with the appropriate charges based on the blended rate calculation. Keep a record of all communications and notifications regarding the blended payment percentages for reference in case of future disputes or audits.

It's also important to train your billing staff on the nuances of the Ambulance Fee Schedule and the blended rate calculation to prevent future occurrences of code N114. Regularly review the Centers for Medicare & Medicaid Services (CMS) updates and guidance on the Ambulance Fee Schedule to stay informed about any changes to the payment calculations or policies.

CARCs Associated to RARC N114

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