Denial code N143

Remark code N143 indicates that the claim was denied because the patient wasn't enrolled in hospice care for some or all service dates.

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What is Denial Code N143

Remark code N143 indicates that the claim submitted for payment reflects service dates during which the patient was not enrolled in a hospice program, either for the entire duration or a portion of the time billed. This remark is used to inform the provider that the patient's hospice status, or lack thereof, is affecting the processing or payment of the claim.

Common Causes of RARC N143

Common causes of code N143 are:

1. Incorrect patient status information was entered on the claim, suggesting the patient was in hospice when they were not.

2. The service dates on the claim overlap with dates the patient was not enrolled in a hospice program.

3. The claim was submitted with a hospice modifier or condition code inappropriately, leading to a mismatch with the patient's actual hospice enrollment status.

4. There may have been an administrative error where the patient was mistakenly flagged as a hospice patient in the provider's billing system.

5. The patient may have been discharged from the hospice program during the billing period, but the claim was not updated to reflect this change.

6. The hospice election form or Notice of Election (NOE) was not filed correctly or on time, causing confusion about the patient's hospice status during the service period.

Ways to Mitigate Denial Code N143

Ways to mitigate code N143 include ensuring accurate patient status documentation before submitting claims. Verify the patient's enrollment in a hospice program for the relevant dates of service through careful coordination with hospice care providers. Implement a pre-claim review process to cross-check the dates of service with hospice program enrollment records. Additionally, maintain open communication channels with hospice facilities to confirm program participation and update billing records accordingly to prevent discrepancies that could lead to this code being applied.

How to Address Denial Code N143

The steps to address code N143 involve verifying the patient's hospice enrollment status for the service dates in question. First, review the patient's records and confirm the dates of hospice enrollment with the appropriate hospice program administrator. If the patient was indeed not in hospice care for part or all of the service dates, adjust the billing records to reflect the accurate dates of service that are eligible for payment. If the patient was in hospice care and the code appears to be an error, gather the necessary documentation that proves hospice enrollment during the specified dates and resubmit the claim with this supporting information. Additionally, communicate with the payer to clarify any discrepancies and ensure that future claims are processed correctly based on the patient's hospice status.

CARCs Associated to RARC N143

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