Remark code N70 indicates that consolidated billing and payment rules apply to the claim. This means that the services billed are subject to payment rules that consolidate multiple service charges into a single bundled payment. Healthcare providers should be aware that individual services included in the claim may not be separately reimbursable when this remark code is present.
Common causes of code N70 are:
1. Services were provided during an inpatient stay, and the services are covered under a consolidated billing plan, such as in a Skilled Nursing Facility (SNF) or Inpatient Rehabilitation Facility (IRF).
2. The healthcare provider billed for services that should be included in a bundled payment or global surgery payment, and separate reimbursement is not allowed.
3. The claim includes items or services that are considered part of the facility's per diem rate under a consolidated billing arrangement.
4. The procedure or service was performed during a period covered by a Home Health Agency (HHA) episode of care, where the HHA is responsible for billing Medicare.
5. The billing was done by a provider who is not recognized as the primary provider for the services during the period specified, as the primary provider has a consolidated billing agreement in place.
6. The claim was submitted for a patient enrolled in a Medicare Advantage plan or another managed care plan that requires consolidated billing, and the provider is not following the plan's billing protocols.
7. The provider failed to use appropriate condition codes or modifiers that indicate the service is exempt from consolidated billing requirements.
Ways to mitigate code N70 include ensuring that all services provided are accurately documented and billed under the appropriate facility or provider. It's essential to have a clear understanding of the consolidated billing rules for the specific type of healthcare facility, such as a Skilled Nursing Facility (SNF) or Home Health Agency (HHA), and to verify that claims are submitted following these guidelines. Regularly reviewing and updating billing practices to align with the latest consolidated billing requirements can help prevent this code from appearing on remittance advice. Additionally, implementing a robust verification process to check that all services are included in the consolidated bill before submission can reduce the likelihood of receiving code N70. Training staff on the nuances of consolidated billing and conducting periodic audits to ensure compliance with billing regulations are also effective strategies to avoid this remark code.
The steps to address code N70 involve reviewing the patient's billing records to ensure that all services provided are included in the consolidated bill. If services are missing, amend the bill to include these services. Next, verify that the services billed are covered under the consolidated billing rules for the patient's specific plan or program. If services are incorrectly billed outside of the consolidated bill, reprocess them within the correct consolidated billing framework. Communicate with the payer to confirm that the bill has been received and processed according to the consolidated billing requirements. If there are discrepancies or denials, work with the payer to resolve these issues and resubmit any necessary documentation or corrected claims. Ensure that your billing system is updated to reflect the consolidated billing requirements for future claims to prevent reoccurrence of this issue.