Remark code N195 indicates that the technical component of a service provided must be billed separately from the professional component. This typically applies to diagnostic tests or procedures where there are distinct charges for the use of equipment and facilities (technical component) and for the professional services of interpreting the results (professional component). Healthcare providers should ensure that their billing processes are set up to itemize these components as required to avoid claim denials or delays in payment.
Common causes of code N195 are:
1. The technical component of a service was included in the billing when it should have been itemized separately.
2. The claim was submitted without differentiating between the professional and technical components.
3. Incorrect use of modifier indicating that both professional and technical components are provided by the same entity when they are not.
4. The billing system automatically bundled the technical component with other services, leading to an inaccurate claim.
5. The claim lacks the necessary modifier to indicate that the technical component is billable separately in the case of certain diagnostic tests or procedures.
6. Misinterpretation of billing guidelines for services that require the technical component to be billed separately.
7. The payer's specific billing requirements for the technical component were not followed.
Ways to mitigate code N195 include ensuring that billing processes are set up to itemize the technical component of services provided. This involves training billing staff to recognize when procedures have both a professional and a technical component and to bill them on separate claim lines. Implementing a robust charge capture system that automatically differentiates and bills for these components can also help. Regular audits of billing practices can identify and correct any issues before claims are submitted, reducing the likelihood of receiving this remark code. Additionally, staying updated on payer-specific billing requirements for procedures that have separate technical and professional components is crucial for compliance and preventing this code from occurring.
The steps to address code N195 involve reviewing the claim to ensure that the technical component of the service provided is billed on a separate line item. This may require splitting the claim into two parts: one for the technical component and another for the professional component. Verify that the correct modifiers are used to distinguish between the two components. Once the claim has been adjusted to reflect this separation, resubmit it to the payer for processing. Additionally, ensure that your billing system is set up to automatically separate these components for future claims to prevent recurrence of this issue.