Remark code N88 is an alert indicating that the current payment is conditional. It notifies the provider that an HHA (Home Health Agency) episode of care notice is on file for the patient in question. Under consolidated billing rules, certain therapy services and supplies should be included in the HHA's payment. Therefore, if it is later determined that the patient was receiving treatment under a HHA episode of care at the same time, the payment issued will need to be recouped from the provider.
Common causes of code N88 are:
1. The patient is currently under a Home Health Agency (HHA) episode of care, and the services billed should be included in the HHA's consolidated billing.
2. The provider billing for the service or supply may not be aware that the patient is receiving treatment under a HHA episode of care.
3. There may be a lack of communication or coordination between the billing provider and the HHA regarding the patient's current care plan and associated billing responsibilities.
4. The claim was submitted without checking the patient's current HHA episode status, leading to a conditional payment that may need to be recouped.
5. The billing system or process did not flag the service or supply as being subject to HHA consolidated billing requirements.
6. There may be errors or delays in the HHA's notification process to other providers about the patient's episode of care status.
Ways to mitigate code N88 include implementing a thorough verification process for each patient's current care episodes before submitting claims. This process should involve checking the patient's active Home Health Agency (HHA) episodes of care to ensure that the services billed are not subject to consolidated billing under the HHA. Additionally, maintaining clear communication with the HHA and other providers involved in the patient's care can help identify any overlapping services that should be included in the HHA's payment. Establishing a system to flag potential HHA episodes and routinely updating the patient's records with their current care status can also prevent this conditional payment situation. Finally, training billing staff on the specifics of consolidated billing requirements for patients under HHA care will help in recognizing services that may be subject to recoupment and managing them accordingly.
The steps to address code N88 involve a thorough review of the patient's current home health agency (HHA) episode of care status. First, verify if the patient is indeed under an HHA episode of care during the service period in question. If so, coordinate with the HHA to determine which services are included in their consolidated billing. If the services you provided are part of the HHA's responsibility, you will need to adjust your billing accordingly and may need to refund the payment received. To prevent future occurrences, establish a communication protocol with local HHAs to confirm a patient's status before providing services that may be subject to consolidated billing. Additionally, ensure that your billing system includes checks for HHA episodes of care to avoid conditional payments that must be recouped.