Remark code N92 indicates that the claim has been processed with the understanding that the facility where the service was provided is not certified to perform digital mammography. This could impact reimbursement if certification is a requirement for payment. Providers should ensure that they have the necessary certifications for the services they offer to avoid claim denials or payment issues related to remark code N92.
Common causes of code N92 are:
1. The facility has not completed the certification process for digital mammography with the appropriate regulatory body.
2. The facility's certification for digital mammography has expired or was revoked.
3. There may be an error in the claim submission indicating the wrong facility or service.
4. The facility's accreditation information for digital mammography may not be updated in the payer's system.
5. The claim was submitted for a digital mammography service, but the facility is only certified for analog mammography.
Ways to mitigate code N92 include ensuring that your facility undergoes the necessary certification process for digital mammography. This involves meeting the standards set by the appropriate accrediting body and obtaining the certification before submitting claims for digital mammography services. Regularly review and update your facility's certifications to maintain compliance and avoid this denial reason. Additionally, staff training on the requirements for digital mammography services and proper claim documentation can help prevent this code from appearing on remittance advice.
The steps to address code N92 involve several key actions to ensure compliance and reimbursement for digital mammography services. Firstly, verify the accuracy of the code by reviewing the services provided and the facility's certification status. If the facility is indeed certified, provide the necessary documentation to the payer to correct the error. This may include the certification number and date of issue.
If the facility is not certified, halt the provision of digital mammography services until certification is obtained. Begin the process of certification immediately if the facility intends to offer digital mammography. This will involve meeting the standards set by the appropriate certifying body and may require equipment upgrades, staff training, and a formal application process.
Once certification is achieved, update the facility's billing information to reflect the new status and resubmit any claims that were denied due to the lack of certification. Going forward, ensure that the facility's certification is maintained and that any renewals are managed in a timely manner to prevent future denials related to code N92.