Denial code 187 is related to Consumer Spending Account payments, which can include various types of accounts such as Flexible Spending Account (FSA), Health Savings Account (HSA), Health Reimbursement Account (HRA), and others. This denial code indicates that the payment made through a consumer spending account has been denied for some reason. The specific reason for the denial may vary and would need to be further investigated to determine the cause.
Common causes of code 187 are:
1. Incorrect or incomplete information: One of the most common causes of code 187 is when the healthcare provider submits incorrect or incomplete information related to consumer spending account payments. This can include errors in patient identification, account numbers, or payment details.
2. Lack of documentation: Another common cause is the lack of proper documentation to support the consumer spending account payments. This can include missing receipts, invoices, or other necessary documentation that verifies the payment made through the account.
3. Non-covered services: Code 187 may also be triggered when the consumer spending account is used to pay for services that are not covered by the account. This can happen if the healthcare provider mistakenly bills for services that are not eligible for payment through the consumer spending account.
4. Exceeded account limits: If the consumer spending account has a limit or cap on the amount that can be used for payment, exceeding this limit can result in code 187. This can occur if the healthcare provider bills for services that exceed the available balance in the account.
5. Invalid or expired account: Code 187 can also be caused by using an invalid or expired consumer spending account for payment. This can happen if the account has been closed, terminated, or if the account information provided is incorrect.
6. Billing errors: In some cases, code 187 may be the result of billing errors made by the healthcare provider. This can include incorrect coding, billing for duplicate services, or other mistakes in the billing process.
It is important for healthcare providers to review and address these common causes to minimize denials and ensure timely reimbursement for consumer spending account payments.
Ways to mitigate code 187 (Consumer Spending Account payments) include:
1. Verify eligibility: Before providing services, ensure that the patient's Consumer Spending Account is active and covers the specific services being rendered. This can be done by checking the account status with the account administrator or through an automated eligibility verification system.
2. Obtain pre-authorization: For high-cost procedures or services, it is advisable to obtain pre-authorization from the Consumer Spending Account administrator. This helps in confirming coverage and reduces the risk of denials due to lack of pre-approval.
3. Accurate coding: Assign the appropriate CPT and ICD-10 codes that accurately reflect the services provided and the medical necessity. Ensure that the codes align with the guidelines provided by the payer and are supported by proper documentation.
4. Clear documentation: Maintain detailed and comprehensive documentation of the services rendered, including the medical necessity, diagnosis, treatment plan, and any supporting documentation. This helps in justifying the services billed and provides evidence in case of a denial.
5. Timely submission: Submit claims for Consumer Spending Account payments promptly, adhering to the payer's specified timelines. Late submissions can lead to denials, so it is crucial to stay organized and submit claims within the designated time frame.
6. Appeal denials: In case of a denial, thoroughly review the denial reason and supporting documentation. If the denial appears to be incorrect or unjustified, file an appeal with the necessary documentation and any additional information that supports the claim's validity.
7. Stay updated with policy changes: Keep track of any changes in the Consumer Spending Account policies, coverage limitations, or billing requirements. Regularly review updates from the payer to ensure compliance and minimize the risk of denials.
By implementing these strategies, healthcare providers can mitigate code 187 denials related to Consumer Spending Account payments and improve their revenue cycle management.
The steps to address code 187, which pertains to Consumer Spending Account payments, are as follows:
- Review the claim details: Carefully examine the claim to ensure that the Consumer Spending Account payment information has been accurately recorded. Check for any discrepancies or errors in the payment amount or account details.
- Verify eligibility: Confirm that the patient's Consumer Spending Account is active and valid for the dates of service mentioned in the claim. This can be done by cross-referencing the account information with the relevant healthcare provider's records or contacting the account administrator directly.
- Check documentation: Ensure that all necessary documentation related to the Consumer Spending Account payment is included in the claim. This may include copies of receipts, invoices, or any other supporting documents that validate the payment.
- Correct any errors: If any errors or inaccuracies are identified in the claim, make the necessary corrections. This may involve updating the payment amount, account number, or any other relevant information. Ensure that the corrected information is clearly communicated to the payer.
- Resubmit the claim: Once all necessary adjustments have been made, resubmit the claim to the payer for reconsideration. Include any additional documentation or explanations that may help clarify the Consumer Spending Account payment.
- Follow up with the payer: Monitor the status of the claim and follow up with the payer if necessary. Keep track of any communication or correspondence related to the code 187 denial and provide any requested information promptly.
- Appeal if needed: If the denial persists despite taking the above steps, consider filing an appeal with the payer. Provide any additional evidence or documentation that supports the validity of the Consumer Spending Account payment.
By following these steps, healthcare providers can effectively address code 187 denials related to Consumer Spending Account payments and work towards resolving the issue in a timely manner.