Remark code N82 indicates that the provider is required to accept the payment from the insurance as complete payment for the service provided, in accordance with the terms specified by a third-party payer contract that stipulates the provider will be fully reimbursed by the payer.
Common causes of code N82 are:
1. The provider has billed the patient for an amount in addition to what the insurance has already paid, despite a contractual agreement with the third-party payer that stipulates the insurance payment constitutes payment in full.
2. There may be a misunderstanding or lack of awareness on the provider's part regarding the contract terms with the insurance company.
3. Incorrect processing or application of the contractual adjustment by the provider's billing staff, leading to an improper balance billed to the patient.
4. The provider's billing system may not be updated to reflect the current terms of the contract with the payer, resulting in automatic generation of balance bills to patients.
5. There could be a discrepancy between the actual contract terms and the information entered into the provider's practice management or billing software.
6. The Explanation of Benefits (EOB) or Electronic Remittance Advice (ERA) might have been misinterpreted by the billing staff, causing them to incorrectly bill the patient for the remaining balance.
Ways to mitigate code N82 include implementing a robust verification process to ensure that the terms of all third-party payer contracts are clearly understood and adhered to by the billing staff. Regular training sessions should be conducted to keep all relevant personnel updated on the specifics of payer contracts, including clauses that stipulate acceptance of insurance payment as payment in full. Additionally, employing automated software that flags potential discrepancies between billed charges and contracted rates can help prevent this issue. It's also crucial to perform periodic audits of billing and coding practices to ensure compliance with all third-party payer agreements.
The steps to address code N82 involve reviewing the contractual agreement with the third-party payer to ensure compliance with the terms that stipulate accepting the insurance payment as payment in full. If the payment received aligns with the contracted rate, adjust the patient's account to reflect no additional payment is due. In cases where the payment appears incorrect, initiate a dialogue with the payer to clarify and rectify any discrepancies. Ensure that all billing staff are aware of the contract terms to prevent future occurrences of this issue. Document all actions taken for compliance and audit purposes.