Denial code N787

Remark code N787 alerts that PHP patients must receive a minimum of 20 hours weekly as per 42 CFR 410.43, following the care plan.

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What is Denial Code N787

Remark code N787 is an alert indicating that, under 42 CFR 410.43, an eligible Partial Hospitalization Program (PHP) patient/beneficiary must receive a minimum of 20 hours of PHP services per week, as detailed in their plan of care. Additionally, the PHP services must be provided in accordance with the plan of care.

Common Causes of RARC N787

Common causes of code N787 are:

1. The patient/beneficiary received fewer than the required 20 hours of Partial Hospitalization Program (PHP) services per week.

2. The plan of care documentation does not clearly support or detail the provision of the minimum required 20 hours of PHP services per week.

3. PHP services were provided but not in strict accordance with the established plan of care.

4. There was an error in coding or billing that inaccurately reflected the number of hours of PHP services provided.

5. Inadequate or incomplete documentation to substantiate that PHP services were furnished according to the plan of care and met the 20-hour weekly minimum.

Ways to Mitigate Denial Code N787

Ways to mitigate code N787 include ensuring comprehensive documentation and adherence to the prescribed plan of care for each Partial Hospitalization Program (PHP) patient. This involves:

1. Initial and Ongoing Assessments: Conduct thorough initial assessments to establish a clear and justified need for PHP services. Regularly review and update the patient's plan of care to reflect their current needs and progress, ensuring it always supports the necessity for a minimum of 20 hours of PHP services per week.

2. Detailed Service Documentation: Maintain meticulous records of all services provided, including dates, times, and durations, to demonstrate that the patient is receiving the minimum required hours of PHP services per week. This documentation should clearly align with the goals and interventions outlined in the plan of care.

3. Plan of Care Compliance: Regularly verify that the services being provided to the patient strictly adhere to the established plan of care. This includes ensuring that all PHP services are not only scheduled according to the plan but are also executed as intended.

4. Staff Training and Awareness: Educate all involved healthcare providers and staff about the importance of adhering to the 20-hour minimum requirement for PHP services. Ensure they understand how to properly document services in a way that supports compliance with this requirement.

5. Regular Auditing: Implement a routine auditing process to review patient files and service documentation. This will help identify any discrepancies or areas of non-compliance early on, allowing for timely corrections before they result in remark code N787.

6. Patient Engagement and Education: Engage with patients to ensure they understand their plan of care, the importance of their participation in the prescribed PHP services, and how it relates to their treatment goals. This can help in reducing missed sessions and ensuring the patient receives the minimum required hours of service.

By proactively addressing these areas, healthcare providers can significantly reduce the likelihood of encountering remark code N787 and ensure that their PHP patients receive the appropriate level of care as mandated.

How to Address Denial Code N787

The steps to address code N787 involve a thorough review and adjustment of the patient's plan of care to ensure compliance with the 20-hour minimum service requirement for Partial Hospitalization Programs (PHP). Begin by auditing the current plan of care documentation to confirm the total hours of PHP services scheduled per week. If the total falls short of the 20-hour minimum, collaborate with the clinical team to identify additional necessary services or therapies that can be incorporated to meet the requirement. Update the plan of care accordingly and ensure that all PHP services are clearly documented, including the type of service, the provider, and the duration of each session. Once the plan of care is adjusted, resubmit the claim with the updated documentation to demonstrate compliance with the 20-hour minimum requirement. Additionally, implement a process for ongoing monitoring of PHP plans of care to prevent future occurrences of this issue.

CARCs Associated to RARC N787

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