Remark code N6 indicates that, according to the Federal Employees Health Benefits (FEHB) law (U.S. Code 8904(b)), the payer cannot reimburse a higher amount for the provided healthcare services than what would have been allowed if the patient had been enrolled in Medicare Part A and/or Part B. This code is used to inform the healthcare provider of the payment limitations set by FEHB when coordinating benefits with Medicare.
Common causes of code N6 are instances where the patient has Federal Employees Health Benefits (FEHB) coverage, and the billed amount exceeds the Medicare allowable amount for the same service. This can occur when providers do not adjust their charges for FEHB plan members to align with Medicare rates, or when there is a misunderstanding of the FEHB payment limitations in relation to Medicare. Additionally, this code may be used if there is a lack of coordination between FEHB and Medicare benefits for a patient who is eligible for both.
Ways to mitigate code N6 include ensuring that billing staff are well-versed in the Medicare fee schedule and limits for covered services. It's essential to verify if the patient has Medicare Part A and/or Part B and to understand the coordination of benefits between FEHB and Medicare. Regularly updating the charge master to align with Medicare allowable charges can also help prevent this code. Additionally, implementing a robust verification process for patient coverage before services are rendered will aid in identifying the correct primary payer and in avoiding billing errors that lead to this remark code. Training staff to recognize services that may be impacted by this regulation and to apply the appropriate adjustments in advance can further reduce the occurrence of code N6.
The steps to address code N6 involve verifying the patient's Medicare eligibility and benefits. If the patient is eligible for Medicare but not enrolled, inform them of the potential benefits of enrollment. Next, review the Explanation of Benefits (EOB) to understand the Medicare allowable amount for the services rendered. Adjust the patient's bill to reflect the Medicare rates, ensuring that the charges do not exceed what Medicare would have paid. If necessary, reprocess the claim with the adjusted charges. Document all actions taken and maintain clear communication with the patient regarding any changes to their bill or responsibility.