Remark code N151 indicates that payment for telephone contact services is being withheld because the required face-to-face interaction between the healthcare provider and the patient has not yet occurred. To receive reimbursement for these services, the provider must first meet the face-to-face contact requirement as stipulated by the payer's policy.
Common causes of code N151 are:
1. The healthcare provider billed for telehealth or telephone services before a required face-to-face encounter with the patient was documented.
2. The claim was submitted without the necessary documentation to prove that a face-to-face visit occurred prior to the telehealth services.
3. There may have been a misunderstanding or lack of knowledge about the specific payer's policy regarding the prerequisites for telehealth reimbursement.
4. The face-to-face requirement was met, but the claim was not coded correctly to reflect this, leading to an erroneous denial.
5. The claim's date of service for the telehealth or telephone interaction may precede the date of the required face-to-face service, causing the claim to be rejected.
6. The provider may have failed to obtain or document the appropriate consent from the patient for telehealth services, which is sometimes tied to the face-to-face requirement.
7. Incorrect use of modifiers or procedure codes that do not align with payer guidelines for telehealth services following a face-to-face visit.
Ways to mitigate code N151 include ensuring that all billing for telephone contact services is preceded by the necessary face-to-face encounters as mandated by the payer's guidelines. It is important to establish a clear process for documenting these face-to-face visits in the patient's record before submitting claims for telephone services. Additionally, staff should be trained to verify that the face-to-face requirement has been fulfilled and to understand the specific conditions under which telephone services are billable. Regular audits of billing practices can also help identify and correct any issues before claims are submitted, reducing the likelihood of receiving this remark code.
The steps to address code N151 involve verifying that the face-to-face encounter required by the payer has indeed taken place before billing for telephone contact services. If the encounter has occurred, ensure that proper documentation is in the patient's record and that the claim reflects this. If the face-to-face meeting has not happened, schedule it as per the payer's guidelines. Once the requirement is fulfilled, resubmit the claim with the appropriate documentation to support the face-to-face service. Additionally, review your billing processes to ensure that future claims for telephone services are only submitted after verifying that face-to-face requirements are met to prevent this denial in the future.