Denial code 116 is related to the advance indemnification notice signed by the patient not complying with the necessary requirements.
Common causes of code 116 are:
1. Inadequate or incomplete advance indemnification notice: The advance indemnification notice signed by the patient may not have met the specific requirements set forth by the payer. This could include missing or incorrect information, such as the patient's signature, date, or specific language that needs to be included.
2. Failure to obtain a signed advance indemnification notice: The healthcare provider may have neglected to obtain a signed advance indemnification notice from the patient altogether. This could be due to oversight or lack of awareness of the payer's requirements.
3. Inaccurate or outdated advance indemnification notice: The advance indemnification notice used by the healthcare provider may be inaccurate or outdated, not reflecting the current requirements set by the payer. This could result in the denial of the claim.
4. Non-compliance with specific language requirements: Payers often have specific language requirements that must be included in the advance indemnification notice. If the notice does not contain the necessary language, the claim may be denied under code 116.
5. Missing supporting documentation: Along with the advance indemnification notice, payers may require additional supporting documentation to be submitted with the claim. Failure to include these documents or providing incomplete documentation can lead to the denial of the claim under code 116.
6. Lack of patient understanding or consent: In some cases, the denial may occur because the patient did not fully understand or consent to the terms outlined in the advance indemnification notice. This could be due to poor communication or inadequate explanation of the notice by the healthcare provider.
It is important for healthcare providers to review and understand the specific requirements set by each payer regarding advance indemnification notices to avoid denials under code 116. Regularly updating and educating staff on these requirements can help minimize the occurrence of this denial code.
Ways to mitigate code 116 include ensuring that the advance indemnification notice signed by the patient meets all the necessary requirements. This can be achieved by thoroughly reviewing the notice before it is presented to the patient, making sure that it contains all the required information and is properly filled out. Additionally, healthcare providers should regularly educate their staff on the specific requirements for the advance indemnification notice to avoid any potential errors or omissions. By taking these proactive measures, providers can minimize the risk of receiving code 116 denials.
The steps to address code 116 are as follows:
- Review the advance indemnification notice: Carefully examine the advance indemnification notice signed by the patient to identify any deficiencies or non-compliance with the requirements.
- Identify the specific requirements not met: Determine which specific requirements were not met by comparing the signed notice with the applicable regulations or guidelines. This could include missing information, incorrect language, or failure to include necessary disclosures.
- Communicate with the patient: Contact the patient to discuss the issue and explain the deficiencies found in the advance indemnification notice. Provide clear instructions on what needs to be corrected or added to ensure compliance.
- Update the advance indemnification notice: Work with the patient to update the notice to meet the necessary requirements. This may involve obtaining additional signatures, adding missing information, or making necessary revisions.
- Retain documentation: Keep a record of all communication and documentation related to the correction of the advance indemnification notice. This will serve as evidence of compliance in case of any future audits or inquiries.
- Educate staff and improve processes: Use this opportunity to educate your staff on the importance of complying with advance indemnification notice requirements. Review your internal processes to identify any areas for improvement to prevent similar issues in the future.
- Submit corrected documentation: Once the advance indemnification notice has been updated and is in compliance with the requirements, submit the corrected documentation to the appropriate parties, such as insurance companies or regulatory bodies.
By following these steps, you can effectively address code 116 and ensure that your advance indemnification notices comply with the necessary requirements.