Are you facing recurring claim denials due to Remark code N123? This code signals a split service, indicating that only a portion of the units from the originally submitted service are being billed. Navigating these denials can be challenging, but with a clear understanding of the underlying issues and effective strategies, you can significantly improve your claim acceptance rate.
What are Split Services?
Split services occur when both a physician and a non-physician practitioner (NPP) from the same group perform an evaluation and management (E/M) visit. For Medicare, these services must be facility-based, and the provider who delivers the “substantive portion” of the visit is responsible for billing.
Common Reasons for N123 Denials
Several factors can lead to N123 denials:
- Incorrect Unit Reporting: When the units charged on your claim do not accurately reflect the entire service provided, you may encounter denials.
- Exceeding Payment Limits: Claims that exceed fee schedules or contracted rates can be denied.
- Misaligned Units and Coverage: Ensure that the reported units align with applicable coverage guidelines to avoid denials.
- Documentation Errors: Incomplete or inaccurate documentation often leads to denials.
- Medical Decision Making (MDM) Discrepancies: When the provider who performs the MDM does not bill the visit, it can result in denials.
Key Considerations for Split Services
- Facility Setting: Split services are only allowed in facility-based settings for Medicare patients.
- Group Practice Requirement: Both the physician and NPP must be part of the same group or employed by the same employer.
- SNF and NF Exclusions: Split services cannot be reported in skilled nursing facility (SNF) or nursing facility (NF) settings.
Strategies to Prevent N123 Denials
- Accurate Unit Reporting: Ensure that the units billed accurately reflect the services provided.
- Code Selection: Use appropriate CPT or HCPCS codes to represent the services rendered.
- Modifier Usage: Employ the correct modifiers to indicate split services and other relevant information.
- Documentation Review: Regularly review medical records to ensure they support the billed services.
- Billing System Optimization: Utilize technology to flag potential issues and automate claim review processes.
Partnering with Claims Med
By understanding the nuances of split services and implementing effective strategies, you can significantly reduce N123 denials and improve your practice’s revenue cycle. If you face persistent challenges, consider partnering with a reputable revenue cycle management (RCM) solution like Claims Med. Our experts can provide tailored guidance and support to help you optimize your billing processes and maximize your reimbursement.
Contact Claims Med: Reach out to Claims Med for tailored assistance in addressing Remark Code N123 denials and improving your revenue cycle management. Our experts provide comprehensive revenue cycle management solutions to help healthcare providers reduce denials and maximize reimbursements.