Remark code N90 indicates that the service is reimbursable only when it is performed by the attending physician who is directly responsible for the patient's care.
Common causes of code N90 are:
1. The service was provided by a healthcare professional other than the attending physician, such as a nurse practitioner, physician assistant, or a different physician.
2. The claim was submitted without proper identification or documentation to establish that the attending physician performed the service.
3. There may be a mismatch between the National Provider Identifier (NPI) on the claim and the designated attending physician's NPI.
4. The procedure or service may be part of a bundled service where the attending physician is not recognized as the provider.
5. Incorrect use of modifiers that do not align with the attending physician's role in the service provided.
6. The payer's policy may require direct supervision or performance by the attending physician, which was not met or documented.
7. The claim may lack the necessary attestation or signature from the attending physician to confirm their role in the service.
Ways to mitigate code N90 include ensuring that the services billed are performed by the attending physician as designated in the patient's records. It's important to verify the provider's status and relationship to the patient before submitting the claim. Additionally, maintain clear documentation that demonstrates the attending physician's involvement in the service provided. Regularly train billing staff to recognize which services require an attending physician's direct involvement and to check that claims for these services are accurately attributed to the correct provider. Implementing a pre-claim review process to catch any discrepancies can also help prevent this code from appearing on remittance advice.
The steps to address code N90 involve verifying the provider's status who performed the service. If the service was indeed performed by a non-attending physician, you may need to contact the attending physician to see if they can legitimately bill for the service. If the attending physician did perform the service, ensure that their National Provider Identifier (NPI) is correctly listed on the claim. If there was an error, correct the NPI information and resubmit the claim. If the claim was correctly submitted, you may need to appeal the decision with supporting documentation that confirms the attending physician's role in the service provided. Additionally, review your billing practices to ensure that future claims for similar services are submitted with the correct provider information from the outset.