Remark code N68 indicates that a previous payment is being reversed because it was later discovered that the patient was covered under a demonstration project at the location where services were provided. The professional services in question were included in the payment that was made to the facility. As a healthcare provider, you are required to reach out to the facility to receive your payment. Additionally, if you received any payment for this claim from the patient or another insurer, you must return those funds to the original payer within 30 days.
Common causes of code N68 are:
1. The patient was found to be part of a demonstration project after the initial payment was made, which affects the coverage and payment responsibilities.
2. Professional services were already included in a bundled payment made to the facility, resulting in duplicate payments.
3. The healthcare provider received a payment directly from the patient or another insurer that should have been directed to the facility as part of the demonstration project's payment structure.
4. There was a lack of coordination between the billing department and the facility regarding the patient's participation in the demonstration project at the time of billing.
5. Failure to verify the patient's coverage and eligibility for the demonstration project prior to submitting the claim, leading to an incorrect initial payment.
6. Inadequate communication from the payer regarding the patient's involvement in the demonstration project and the impact on payment distribution.
Ways to mitigate code N68 include ensuring that patient coverage information is accurate and up-to-date at the time of service. Implement a robust verification process to confirm whether patients are part of a demonstration project and understand the billing implications for services provided at specific sites. Train staff to recognize demonstration project participants and to coordinate with facilities regarding bundled payments. Regularly review and reconcile payments received to identify any that require refunding, and establish a system for timely refunds within the required 30-day period. Additionally, maintain clear communication channels with facilities to facilitate the transfer of payment responsibilities and to prevent future occurrences of this code.
The steps to address code N68 involve several key actions. First, initiate communication with the facility that received the demonstration project payment to coordinate the transfer of funds for professional services rendered. Ensure that you have all the necessary documentation regarding the services provided and the initial payment received.
Next, review your records to identify any payments made by the patient or another insurer for the same claim. Once identified, process the refunds to the appropriate payer. It's critical to adhere to the 30-day timeframe for issuing refunds to avoid any compliance issues or potential penalties.
Additionally, update your billing system to reflect the cancellation of the prior payment and the subsequent adjustments to the claim. This will help prevent any future confusion or errors in your accounts receivable.
Finally, document all communications and transactions related to the code N68 resolution. This documentation will serve as proof of your compliance with the payer's instructions and can be valuable in case of any disputes or audits.