Remark code N246 indicates that the payment for the service provided is subject to limitations set by state regulations. This means that there are specific rules or caps established by the state government that restrict the amount that can be billed or collected from the patient for this particular service. Healthcare providers should be aware of these limitations when billing and collecting payments to ensure compliance with state laws.
Common causes of code N246 are:
1. The service provided is subject to state-mandated fee schedules or payment limitations, and the billed amount exceeds these limits.
2. Incorrect billing of services that fall under specific state regulatory requirements for patient payments.
3. Failure to apply the appropriate state-regulated adjustments to the claim before submission.
4. Lack of awareness or misunderstanding of the state regulations pertaining to patient payments for the particular service rendered.
5. Inaccurate coding or charge entry that does not align with state-mandated payment rules.
6. The payer has identified the service as one that is regulated by state legislation, and the provider's billing practices did not comply with these regulations.
Ways to mitigate code N246 include ensuring that your billing team is well-versed in state-specific regulations regarding patient payment limitations. Regular training sessions should be conducted to keep staff updated on changes in state laws. Additionally, implementing a robust verification process for understanding each patient's coverage limits before services are rendered can help prevent this code. It's also beneficial to have a system in place that automatically flags services that may exceed state-regulated payment limitations, allowing for preemptive adjustments to care plans or financial agreements. Establishing clear communication channels with payers to discuss and resolve any ambiguities in payment limitations can further reduce the occurrence of this code.
The steps to address code N246 involve reviewing the specific state regulations that pertain to patient payment limitations for the service in question. Ensure that the billing team is aware of the maximum allowable patient responsibility amounts for the services provided. Adjust the patient's bill to reflect these limitations and reissue the bill if necessary. Document the adjustments made in accordance with state regulations in the patient's account to maintain compliance and for future reference. If the adjustment leads to a balance that should be written off, process the write-off according to your organization's financial policies. Communicate with the patient to inform them of the adjustment and any impact on their balance. If the code appears to be applied in error, prepare and submit any necessary documentation to contest the application of the payment limitation.