DENIAL CODES

Denial code N782

Remark code N782 is an alert that the patient is a Medicaid/Medicare Beneficiary, advising to check records for incorrect coinsurance charges.

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What is Denial Code N782

Remark code N782 is an alert indicating that the patient is a Medicaid/Qualified Medicare Beneficiary. Healthcare providers are advised to review their records for any coinsurance amounts that may have been wrongfully collected from the patient. These amounts might be eligible for billing to a subsequent payer instead.

Common Causes of RARC N782

Common causes of code N782 are incorrect patient eligibility verification processes, failure to update patient insurance information in the healthcare provider's system, and oversight in recognizing Medicaid or Qualified Medicare Beneficiary status during the billing process. Additionally, this code may arise from inadequate coordination of benefits when Medicaid is the secondary payer but was not billed as such, or when there is a misunderstanding of the billing rules related to Qualified Medicare Beneficiaries.

Ways to Mitigate Denial Code N782

Ways to mitigate code N782 include implementing a robust verification system for patient insurance status prior to the appointment. This system should automatically flag Medicaid or Qualified Medicare Beneficiary (QMB) patients to prevent the collection of coinsurance from them. Training staff on the importance of accurately identifying and updating patient insurance information in real-time can also help. Additionally, setting up alerts in your billing software to notify billers when a patient is identified as a Medicaid or QMB patient can prevent wrongful billing. Regular audits of patient accounts for compliance with these procedures can further reduce the risk of this issue occurring.

How to Address Denial Code N782

The steps to address code N782 involve a multi-faceted approach to ensure compliance and accurate billing. Initially, conduct a thorough review of the patient's account to confirm their Medicaid or Qualified Medicare Beneficiary status. This involves checking the patient's eligibility and benefits through the appropriate Medicaid or Medicare portal to verify coverage dates and benefits specifics.

Next, audit any previously collected coinsurance amounts for the patient in question. This includes examining dates of service, amounts collected, and comparing these against the patient's coverage to identify any discrepancies or wrongfully collected amounts.

If overpayments are identified, initiate the refund process to the patient or the secondary payer, if applicable. This may involve adjusting the patient's account balance, issuing a refund, and documenting the action taken in the patient's account for future reference.

Simultaneously, update your billing system to flag similar cases in the future automatically. This could involve setting alerts for patients identified as Medicaid or Qualified Medicare Beneficiaries to prevent wrongful coinsurance collection moving forward.

Lastly, provide training or a refresher course for your billing and front desk staff on the importance of verifying coverage before collecting coinsurance and the specific procedures to follow when handling cases involving Medicaid or Qualified Medicare Beneficiaries. This ensures that all team members are aware of the correct process, reducing the likelihood of similar issues occurring in the future.

CARCs Associated to RARC N782

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