How To Fix Remark Code M161 (RARC) | Common Reasons, Next Steps & How To Avoid It
Remark Code MA47 means that the patient has opted out of Medicare and agreed not to bill Medicare for the services, tests, or supplies provided. As a result, the claim cannot be paid by Medicare, and the patient is responsible for payment.
1. Description
Remark Code MA47 indicates that the patient has chosen to opt out of Medicare and has made an agreement with the healthcare provider not to bill Medicare for the services, tests, or supplies furnished. This code has been in effect since January 1, 1997. It is important for healthcare providers to be aware of this remark code to ensure proper billing and reimbursement processes.
2. Common Reasons
- Patient’s decision to opt out of Medicare: The most common reason for Remark Code MA47 is that the patient has voluntarily chosen to opt out of Medicare and has agreed not to seek reimbursement from the program for the services received.
3. Next Steps
- Inform the patient about their financial responsibility: Since Medicare will not pay for the services, tests, or supplies, it is crucial to communicate with the patient and make them aware that they are responsible for payment.
- Provide the patient with an itemized bill: To facilitate payment, healthcare providers should provide the patient with a detailed breakdown of the services, tests, or supplies provided and their associated costs.
- Offer alternative payment options: If the patient is unable to pay the full amount upfront, healthcare providers can explore alternative payment arrangements, such as installment plans or financing options, to help the patient manage their financial responsibility.
4. How To Avoid It
- Educate patients about Medicare opt-out: Healthcare providers should inform patients about the implications of opting out of Medicare and the financial responsibility they will assume for the services received.
- Obtain written agreements: To ensure clarity and avoid any misunderstandings, healthcare providers should obtain written agreements from patients who choose to opt out of Medicare, clearly stating their decision and agreement not to bill Medicare for the services provided.
- Verify patient’s Medicare status: Before providing any services, tests, or supplies, healthcare providers should verify the patient’s Medicare status to determine if they have opted out of the program.
5. Example Cases
- Case 1: A patient has opted out of Medicare and receives a service covered by Medicare. The claim is denied with Remark Code MA47, and the patient is responsible for payment.
- Case 2: A healthcare provider mistakenly bills Medicare for services provided to a patient who has opted out of the program. The claim is denied with Remark Code MA47, and the provider must rectify the situation by billing the patient directly.
Source: Remittance Advice Remark Codes
