How To Fix Remark Code M1077 (RARC) | Common Reasons, Next Steps & How To Avoid It

Remark Code N882 means that the out-of-network payment and cost sharing amounts were based on the plan’s allowance because the provider or facility obtained the patient’s consent to waive the balance billing protections under the No Surprises Act. This code serves as an alert to healthcare providers and insurance companies regarding the billing practices related to out-of-network services.

1. Description

Remark Code N882 indicates that the out-of-network payment and cost sharing amounts were determined based on the plan’s allowance because the provider or facility obtained the patient’s consent to waive the balance billing protections under the No Surprises Act. The official description states: ‘Alert: The out-of-network payment and cost sharing amounts were based on the plan’s allowance because the provider or facility obtained the patient’s consent to waive the balance billing protections under the No Surprises Act.’ This code highlights the importance of obtaining patient consent and adhering to the regulations set forth by the No Surprises Act.

2. Common Reasons

1. Provider or facility obtained patient consent to waive balance billing protections: In certain situations, patients may choose to receive out-of-network services and agree to waive the balance billing protections provided by the No Surprises Act. This can occur when patients have a specific preference for a particular provider or facility.

3. Next Steps

1. Review the patient’s consent documentation: It is crucial to ensure that proper consent was obtained from the patient to waive the balance billing protections. This documentation should be thoroughly reviewed and maintained for future reference.
2. Verify the plan’s allowance for out-of-network services: Understanding the plan’s allowance is essential for accurate billing and reimbursement calculations. This information can be obtained from the insurance company or through the provider’s contract with the plan.
3. Communicate with the patient regarding their financial responsibility: Open and transparent communication with the patient is vital to ensure they are aware of their financial obligations and any potential out-of-pocket expenses.

4. How To Avoid It

1. Obtain clear and explicit patient consent: When offering out-of-network services, it is crucial to obtain written consent from the patient, clearly explaining the potential financial implications and the waiver of balance billing protections.
2. Educate patients about their insurance coverage: Patients should be informed about their insurance coverage, including in-network and out-of-network benefits, and the potential cost differences associated with each option.
3. Ensure accurate and transparent billing: Billing practices should align with the patient’s consent and the plan’s allowance for out-of-network services. Clear and itemized billing statements should be provided to the patient.

5. Example Cases

1. Case 1: A patient receives out-of-network services and provides written consent to waive balance billing protections. The provider bills the patient based on the plan’s allowance, avoiding any surprise billing issues.
2. Case 2: A provider fails to obtain proper patient consent to waive balance billing protections and bills the patient for the full out-of-network charges. This results in a claim denial and potential financial burden for the patient.

Source: Remittance Advice Remark Codes