Remark code N120 indicates that the payment is adjusted according to the Home Health Prospective Payment System (HH PPS) due to a partial episode payment adjustment. This adjustment is applied because the patient was either transferred, discharged, or readmitted during the payment episode, which affects the calculation of the payment amount.
Common causes of code N120 are situations where a patient within the home health care setting is transferred to another facility, discharged, or readmitted within a 60-day episode of care, prompting a partial episode payment adjustment in accordance with the Home Health Prospective Payment System (HH PPS). This adjustment is necessary to account for the change in the expected cost of care due to the alteration in the patient's treatment or care status.
Ways to mitigate code N120 include implementing a robust tracking system for patient admissions, transfers, and discharges to ensure accurate billing for home health services. It's essential to educate your billing staff on the nuances of the Home Health Prospective Payment System (HH PPS) and the conditions that trigger a partial episode payment adjustment. Regularly review and reconcile patient statuses within each payment episode to identify potential overlaps or errors. Additionally, establish clear communication channels with other healthcare facilities to promptly update patient records upon transfers or readmissions, and adjust claims accordingly to reflect these changes. Conduct periodic audits to ensure compliance with the partial episode payment rules and to identify any patterns that may lead to N120 codes, taking corrective actions as needed.
The steps to address code N120 involve a thorough review of the patient's admission and discharge dates to ensure accuracy. First, verify the patient's transfer, discharge, and readmission details against the claim to confirm that the dates and services billed align with the actual events. Next, adjust the billing records to reflect the partial episode payment accurately. If the claim was reduced incorrectly, gather supporting documentation that justifies the full payment for the episode, such as medical records or a detailed explanation of the patient's care needs that prevented transfer or necessitated readmission. Submit any necessary corrections or additional information to the payer to resolve the payment discrepancy. Monitor the claim to ensure the adjustment is processed and follow up as needed to secure appropriate reimbursement.