Denial Code 190 means that the payment for a claim has been included in the allowance for a Skilled Nursing Facility (SNF) qualified stay. Below you can find the description, common reasons for denial code 190, next steps, how to avoid it, and examples.
2. Description
Denial Code 190 is a claim adjustment reason code (CARC) that indicates the payment for a claim has been included in the allowance for a Skilled Nursing Facility (SNF) qualified stay. This means that the payment has already been accounted for and covered under the SNF benefit, and therefore, the claim is denied for duplicate payment.
2. Common Reasons
The most common reasons for denial code 190 are:
- Duplicate Billing: One of the common reasons for denial code 190 is when a claim is submitted for payment that has already been included in the allowance for a Skilled Nursing Facility qualified stay. This can occur if the provider or facility mistakenly bills for services that have already been covered under the SNF benefit.
- Incorrect Coding: Another reason for denial code 190 is incorrect coding. If the services provided are coded in a way that indicates they should be separately reimbursed, rather than being included in the SNF allowance, the claim may be denied under code 190.
- Lack of Documentation: Insufficient or incomplete documentation to support the need for separate reimbursement can also result in denial code 190. If the documentation does not clearly demonstrate that the services provided were not already covered under the SNF benefit, the claim may be denied.
3. Next Steps
You can fix denial code 190 as follows:
- Review the Claim: Carefully review the claim to determine if the services provided were already included in the allowance for a Skilled Nursing Facility qualified stay. Check for any duplicate billing or coding errors that may have led to the denial.
- Correct Coding: If the denial was due to incorrect coding, make sure to correct the coding on the claim. Use the appropriate codes that indicate the services should be included in the SNF allowance rather than being separately reimbursed.
- Provide Additional Documentation: If the denial was due to lack of documentation, gather any additional documentation that supports the need for separate reimbursement. This may include medical records, physician orders, or other relevant documentation that clearly demonstrates the services were not already covered under the SNF benefit.
- Resubmit the Claim: Once you have made the necessary corrections and gathered any additional documentation, resubmit the claim for reconsideration. Include a cover letter explaining the reason for the resubmission and any supporting documentation that has been provided.
- Follow Up: Follow up with the insurance company to ensure that the claim is being processed correctly. If there are any further issues or questions, be prepared to provide any additional information or clarification that may be needed.
4. How To Avoid It
To avoid denial code 190 in the future, consider the following:
- Proper Coding: Ensure that the services provided are coded correctly and indicate that they should be included in the allowance for a Skilled Nursing Facility qualified stay. Use the appropriate codes that align with the SNF benefit.
- Thorough Documentation: Maintain thorough and accurate documentation that clearly supports the need for separate reimbursement. This includes medical records, physician orders, and any other relevant documentation that demonstrates the services were not already covered under the SNF benefit.
- Education and Training: Provide education and training to staff members involved in coding and billing processes. Make sure they understand the specific requirements for coding and billing services related to SNF stays to avoid any errors or misunderstandings.
5. Example Cases
Below are two examples of denial code 190:
- Example 1: A skilled nursing facility submits a claim for physical therapy services provided during a patient’s qualified SNF stay. However, the claim is denied under code 190 because the payment for the services has already been included in the SNF allowance.
- Example 2: A provider mistakenly bills for services that were already covered under the SNF benefit. The claim is denied under code 190 as it is considered duplicate billing.
