Remark code N218 indicates that as a provider, you are required to supply and maintain the specified item for the duration of the patient's need for it. Payment for maintenance and/or servicing is covered for the duration outlined in the payer's contract or coverage manual.
Common causes of code N218 are:
1. The provider has not submitted documentation indicating that the item is still medically necessary for the patient.
2. The claim lacks evidence that the provider is continuing to furnish and service the item as required.
3. There is a discrepancy between the length of time the item has been provided and the duration specified in the patient's contract or coverage manual.
4. The provider has submitted a claim for maintenance and/or servicing outside of the time period covered by the patient's insurance plan.
5. The claim was submitted without proper authorization for extended servicing or maintenance as stipulated by the payer's guidelines.
Ways to mitigate code N218 include implementing a robust tracking system to monitor the duration of equipment rental or usage by patients. Ensure that your billing department has clear guidelines on the specific time periods covered for maintenance and servicing as per the patient's insurance plan. Regularly review and update these guidelines to reflect any changes in insurance contracts or coverage manuals. Additionally, establish a proactive communication channel with patients to confirm their ongoing need for the equipment and to schedule maintenance or servicing within the covered time frame. This will help to avoid unnecessary denials and ensure compliance with the payer's requirements.
The steps to address code N218 involve ensuring that your billing and service delivery teams are aligned on the patient's ongoing needs for the specified item. First, confirm the duration of necessity as outlined in the patient's plan of care or physician's orders. Next, maintain accurate and up-to-date documentation of all services and maintenance provided to support the necessity of the item. Regularly review the patient's status and the equipment's condition to determine if continued servicing is required. If maintenance is performed, ensure that the service dates and details are correctly recorded and that claims for these services are submitted within the time frames stipulated by the payer. Lastly, audit your claims to ensure compliance with the payer's guidelines for servicing and maintenance claims to prevent future denials.