Remark code N135 indicates that the costs associated with record fees fall under the patient's financial responsibility and are confined to the amount designated as the co-payment. This means that the patient is expected to pay for the record fees up to the limit of their co-payment amount as outlined in their insurance policy or agreement.
Common causes of code N135 are instances where the service provided is associated with medical record documentation or copying fees that are not covered by the insurance plan. The patient has a predetermined co-payment for these services, and any charges beyond that co-payment are the patient's responsibility. This code may also appear when the provider has not properly indicated that the fees have been waived or are part of the covered services under the patient's health plan. Additionally, it could be used if there is a misunderstanding between the provider and the payer regarding the inclusion of record fees in the patient's benefits package.
Ways to mitigate code N135 include implementing a robust patient education system that clearly communicates the costs associated with record fees and the specifics of co-payment responsibilities. Ensure that front-end staff are trained to collect co-payments at the time of service and verify patient coverage details to avoid misunderstandings. Additionally, consider integrating a real-time eligibility verification tool within your practice management system to accurately determine patient financial responsibilities before services are rendered. Regularly review and update your financial policy to reflect current regulations regarding record fees and co-payments, and make sure this policy is readily accessible to patients. It's also beneficial to streamline the billing process with clear, itemized statements that differentiate between covered services and those that fall under the patient's co-payment obligation.
The steps to address code N135 involve reviewing the patient's insurance policy to confirm the co-payment amount for record fees. Once confirmed, update the patient's account to reflect the co-payment responsibility. Inform the patient of their obligation, providing a clear breakdown of the charges and the co-payment amount due. Ensure that the billing statement sent to the patient is accurate and includes all necessary information to facilitate prompt payment. If the patient has questions or disputes the charge, have a process in place to handle their inquiries and provide additional clarification or documentation as needed. It's also important to train front desk and billing staff on how to communicate these charges to patients effectively to minimize confusion and disputes.