Remark code N887 explains that non-participating providers can appeal Medicare Advantage Plan decisions on payment denials or discrepancies within 60 days, requiring a Waiver of Liability Statement.
Remark code N887 indicates that providers who are not participating in the Medicare Advantage Plan have the right to appeal if the plan has partially or fully denied payment, or if the provider believes the plan has not paid for the services at the expected Medicare reimbursable rate or type of level/service. Providers must file their appeal in writing within 60 calendar days after the date of the remittance advice. For the plan to review the appeal, a completed signed Waiver of Liability Statement is required. Providers can obtain a Waiver of Liability form by contacting their Medicare Advantage Plan.
Common causes of code N887 are incorrect provider enrollment with the Medicare Advantage Plan, services rendered not covered under the specific Medicare Advantage Plan, billing errors such as incorrect service codes or dates, and discrepancies between billed services and the Medicare reimbursable rate or service level/type expected by the provider.
Ways to mitigate code N887 include ensuring that your practice is fully aware of the participation status with Medicare Advantage Plans. Regularly verify and update your participation status and understand the specific billing guidelines and reimbursement rates for each plan. Before rendering services, confirm the patient's current plan and coverage details to ensure alignment with the services you provide. Implement a robust pre-authorization process to verify coverage for the planned services. Educate your billing staff on the importance of accurate coding and the submission of claims according to the specific Medicare Advantage Plan requirements. In cases where an appeal is necessary, ensure that the appeal is filed promptly within the specified timeframe and that all required documentation, including the Waiver of Liability Statement, is accurately completed and submitted to facilitate the review process. Regular training for staff on changes in Medicare Advantage Plans and billing procedures can also help in preventing issues related to code N887.
The steps to address code N887 involve a systematic approach to appeal the decision made by the Medicare Advantage Plan. Initially, it's crucial to gather all relevant documentation related to the claim, including the original claim submission, the remittance advice indicating code N887, and any supporting medical records or documentation that justifies the services provided. Next, draft a detailed appeal letter that outlines the reasons for the appeal, referencing the specific services and the expected Medicare reimbursable rate or level of service that was anticipated.
In parallel, promptly contact the Medicare Advantage Plan to request a Waiver of Liability Statement, as this is a mandatory document for the appeal process. Once received, carefully review, complete, and sign the Waiver of Liability Statement, ensuring that all information is accurate and aligns with the details provided in the appeal letter.
Compile the appeal letter, the Waiver of Liability Statement, and all supporting documentation into a comprehensive appeal package. Submit this package to the Medicare Advantage Plan within the 60 calendar days timeframe from the date of the remittance advice to ensure the appeal is considered timely.
It's advisable to send the appeal package via a method that provides delivery confirmation or tracking to ensure it is received by the plan. After submission, follow up periodically with the Medicare Advantage Plan to check the status of the appeal, and be prepared to provide additional information or clarification if requested by the plan during their review process.
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