DENIAL CODES

Denial code N879

Remark code N879 indicates balance billing is not allowed for services due to lack of proper consent under the No Surprises Act.

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What is Denial Code N879

Remark code N879 indicates that the notice and consent to balance bill, which was obtained from the patient for the billed services, is not allowed for these specific services. Therefore, the cost sharing and the total payment have been adjusted according to the No Surprises Act rules, prohibiting balance billing for these services.

Common Causes of RARC N879

Common causes of code N879 are:

1. The healthcare provider failed to properly understand or apply the requirements of the No Surprises Act when obtaining consent from the patient.

2. The consent form used was outdated or did not meet the specific criteria outlined under the No Surprises Act for the services provided.

3. There was a misinterpretation of the types of services that are exempt from the No Surprises Act, leading to an incorrect assumption that consent for balance billing was allowed.

4. Administrative errors in documenting or processing the notice and consent forms, resulting in non-compliance with the act's stipulations.

5. Lack of adequate training or communication within the healthcare provider's office regarding the No Surprises Act and its implications for out-of-network services and balance billing practices.

Ways to Mitigate Denial Code N879

Ways to mitigate code N879 include ensuring that all staff involved in patient intake and billing are thoroughly trained on the specifics of the No Surprises Act, particularly regarding which services are covered under the act and the requirements for obtaining valid consent for out-of-network charges. Implement a robust verification process to confirm whether services are considered in-network or out-of-network before patient care is provided, and clearly communicate this status to patients. Develop and maintain updated consent forms that comply with the latest regulations and ensure they are used appropriately. Regularly audit billing and consent procedures to identify and correct any practices that may lead to non-compliance with the No Surprises Act. Establish a clear and accessible patient grievance process to address any disputes related to billing and consent, which can help identify potential issues before they result in code N879.

How to Address Denial Code N879

The steps to address code N879 involve a multi-faceted approach focusing on compliance, patient communication, and billing practices. Initially, it's crucial to review and understand the specific services that were provided and identify why they fall under the No Surprises Act's protection against balance billing. This understanding will guide the adjustment of billing practices for similar future services.

Next, engage with the billing and coding team to ensure they are fully educated on the types of services that are protected under the No Surprises Act. This includes training on how to properly identify and code these services to prevent similar issues from arising.

Following this, it's important to audit the consent forms and notice procedures currently in use. This audit should verify that they are in compliance with the No Surprises Act requirements and do not inadvertently include services that are protected from balance billing. If discrepancies are found, revise the consent forms and notice procedures accordingly.

Additionally, establish a clear communication channel with patients who were affected by this issue. Inform them about the mistake, clarify the adjustments made to their bill in compliance with the No Surprises Act, and reassure them about your commitment to transparent billing practices.

Lastly, implement a system for regularly reviewing and updating your billing practices and patient consent forms. This system should include staying informed on any changes to the No Surprises Act and other relevant legislation to ensure ongoing compliance and prevent recurrence of similar issues.

CARCs Associated to RARC N879

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