Remark code N119 indicates that reimbursement for the service in question is not provided if the claim is submitted more frequently than once every 28 days. Additionally, if the patient has been admitted for an inpatient stay or has been in a Skilled Nursing Facility (SNF) for five or more consecutive days within that 28-day period, payment for the service will also be denied. This code serves as a notification to the provider regarding the limitations on billing frequency and the impact of inpatient or SNF stays on service eligibility for payment.
Common causes of code N119 are billing for a service more frequently than the allowed 28-day period, or the patient having a stay of five or more consecutive days in an inpatient or Skilled Nursing Facility (SNF) within the 28 days prior to the service being billed.
Ways to mitigate code N119 include implementing a tracking system to monitor the frequency of service claims and the patient's inpatient or skilled nursing facility stays. Ensure that billing staff are trained to check patient records for any inpatient or SNF admissions within the 28-day period prior to submitting a claim for the service. Additionally, establish a protocol to coordinate with inpatient or SNF facilities to receive timely updates on patient admissions and discharges. This will help prevent billing for services during the exclusion period and reduce the likelihood of receiving code N119 on claim denials.
The steps to address code N119 involve verifying the patient's inpatient or skilled nursing facility (SNF) stay dates. First, review the patient's medical records and billing history to confirm the dates of service in question. If the service was indeed billed within 28 days of a previous billing and the patient was in an inpatient or SNF setting for five or more consecutive days during this period, the claim will not be reimbursed as per the code guidelines.
If the service was incorrectly denied, gather evidence such as dates of service that fall outside the 28-day window or proof that the patient was not in an inpatient or SNF setting for five or more consecutive days within the 28 days. Once the information is compiled, resubmit the claim with the supporting documentation to justify the service's billing.
If the denial is correct, adjust the billing records to reflect the non-payable service and inform the relevant healthcare provider or department to prevent future occurrences. Additionally, consider implementing a system to track the frequency of such services and patient inpatient/SNF stays to avoid similar denials in the future.