Remark code N67 indicates that professional provider services were not paid separately because they are included in the facility payment under a demonstration project. Providers should apply to that facility for payment, or resubmit the claim if the facility informs them that the patient was excluded from the demonstration, or if the services were provided at a different location on the date of the patient's admission or discharge from a demonstration hospital. If services were provided at a facility not involved in the demonstration on the same date the patient was discharged from or admitted to a demonstration facility, the provider must include the provider ID number for the non-demonstration facility on the new claim.
Common causes of code N67 are:
1. The professional provider's services were rendered as part of a facility's care that is under a demonstration project, where such services are bundled into the facility's payment.
2. The claim was submitted without recognizing that the patient is part of a demonstration project that consolidates payment for services.
3. The provider may have incorrectly billed for services separately when they should have been included in the facility's bundled payment.
4. There is a lack of communication or miscommunication between the facility and the provider regarding the patient's inclusion in the demonstration project.
5. The provider did not include the necessary information indicating that the services were provided at a non-demonstration facility, if applicable, on the date of the patient's admission or discharge from the demonstration hospital.
Ways to mitigate code N67 include ensuring that billing staff are aware of the demonstration projects and their specific billing protocols. Before submitting claims, verify if the services provided are part of a facility payment bundle under a demonstration project. If services were provided at a non-demonstration facility, ensure that the correct provider ID number for that facility is included on the claim. Additionally, maintain open communication with the facility to confirm whether a patient is excluded from the demonstration project, and if so, promptly resubmit the claim with the necessary documentation to support the exclusion. Regular training for billing personnel on the nuances of demonstration projects and their impact on claims submission can also help prevent this code from occurring.
The steps to address code N67 involve several actions. First, verify the location where the services were provided and ensure that they were indeed part of a demonstration project. If the services were provided at a facility participating in the demonstration project, you should contact that facility to seek payment, as professional provider services are included in their facility payment.
If the facility informs you that the patient was excluded from the demonstration project, or if the services were provided at a different location on the date of the patient's admission or discharge from the demonstration hospital, you will need to resubmit the claim. When resubmitting, make sure to include any necessary documentation that supports the exclusion or the provision of services at a different location.
In the case where services were furnished at a non-demonstration facility on the same date the patient was discharged from or admitted to a demonstration facility, it is crucial to report the provider ID number for the non-demonstration facility on the new claim. This will help differentiate the services provided outside of the demonstration project and facilitate proper payment. Ensure that all information on the resubmitted claim is accurate and complete to avoid further delays or denials.