How To Fix Remark Code M1082 (RARC) | Common Reasons, Next Steps & How To Avoid It

Remark Code N887 means that providers who are not participating in the Medicare Advantage Plan have the right to appeal if the plan has partially or fully denied payment or if the provider believes the plan has not paid the services at the expected Medicare reimbursable rate or type of level/service. This code is important for providers to understand their rights and options for appealing denied payments or incorrect reimbursement rates.

1. Description

Remark Code N887 indicates that providers who are not participating in the Medicare Advantage Plan have the right to appeal if the plan has partially or fully denied payment or if the provider believes the plan has not paid the services at the expected Medicare reimbursable rate or type of level/service. The official description states: ‘Providers not participating in the Medicare Advantage Plan have the right to appeal if the plan has partially or fully denied payment or if the provider believes the plan has not paid the services at the expected Medicare reimbursable rate or type of level/service.’ This code empowers providers to take action when they believe they have been unfairly denied payment or reimbursed at an incorrect rate.

2. Common Reasons

1. Partial or full denial of payment: Providers may encounter situations where the Medicare Advantage Plan denies payment for services rendered. This could be due to various reasons such as missing documentation, coding errors, or coverage limitations.
2. Incorrect reimbursement rate or type of level/service: Providers may also face issues where the Medicare Advantage Plan reimburses them at a rate or for a level/service that does not align with the expected Medicare guidelines. This could result in underpayment or incorrect categorization of services.

3. Next Steps

1. File an appeal in writing within 60 calendar days: Providers who wish to appeal a denied payment or incorrect reimbursement rate must submit a written appeal within 60 calendar days from the date of the remittance advice. This ensures that the appeal is timely and can be properly reviewed by the plan.
2. Complete and submit a signed Waiver of Liability Statement: To initiate the appeal process, providers need to include a completed and signed Waiver of Liability Statement along with their written appeal. This form is necessary for the plan to review the appeal and understand the provider’s position.
3. Contact the Medicare Advantage Plan for a Waiver of Liability form: Providers can obtain the Waiver of Liability form by reaching out to their specific Medicare Advantage Plan. It is important to follow the plan’s instructions and provide all required information to ensure a smooth appeal process.
4. Expect a decision within 60 calendar days: Once the completed appeal forms are submitted, providers can anticipate receiving a decision on their appeal within 60 calendar days. This timeframe allows the plan sufficient time to review the appeal and provide a resolution.

4. How To Avoid It

1. Understand the Medicare Advantage Plan’s payment policies: Familiarize yourself with the payment policies of the Medicare Advantage Plan you are not participating in. This will help you anticipate potential issues and take proactive measures to avoid them.
2. Ensure accurate documentation and coding: Properly document and code all services rendered to ensure accurate billing and reimbursement. This includes capturing all necessary information, using appropriate codes, and providing supporting documentation when required.
3. Stay informed about Medicare guidelines: Stay updated with the latest Medicare guidelines to ensure that your services align with the expected reimbursable rates and types of level/service. This will help you identify any discrepancies and take appropriate action.

5. Example Cases

1. Case 1: A provider submits a claim to a Medicare Advantage Plan for a specific service but receives a partial denial of payment. The provider files an appeal within 60 calendar days, including a completed Waiver of Liability Statement. After the review process, the plan determines that the denial was incorrect, and the provider receives the full payment for the service.
2. Case 2: A provider notices that the Medicare Advantage Plan has reimbursed them at a lower rate than expected for a particular level of service. The provider decides to file an appeal, providing all necessary documentation and the Waiver of Liability Statement. After the review, the plan acknowledges the error and adjusts the reimbursement rate to the appropriate level.

Source: Remittance Advice Remark Codes