How To Fix Remark Code M165 (RARC) | Common Reasons, Next Steps & How To Avoid It

Remark Code MA54 means that the physician certification or election consent for hospice care was not received in a timely manner. This code is used to indicate the reason for denial or adjustment of a claim related to hospice care.

1. Description

Remark Code MA54 indicates that the physician certification or election consent for hospice care was not received in a timely manner. The official description states: ‘Physician certification or election consent for hospice care not received timely.’ This means that the necessary documentation to support the provision of hospice care was not submitted within the required timeframe.

2. Common Reasons

1. Physician certification not obtained: One of the most common reasons for Remark Code MA54 is the failure to obtain the necessary certification from the physician. This certification is crucial to establish the patient’s eligibility for hospice care.
2. Election consent not received: Another common reason is the absence of the patient’s election consent for hospice care. This consent is required to confirm the patient’s decision to receive hospice services.
3. Documentation not submitted in a timely manner: Delays in submitting the required documentation can result in Remark Code MA54. It is essential to ensure that all necessary paperwork is completed and submitted promptly.
4. Incomplete or inaccurate documentation: If the submitted documentation is incomplete or contains errors, it may lead to Remark Code MA54. It is crucial to review all documentation for accuracy and completeness before submission.

3. Next Steps

1. Contact the physician: If the physician certification is missing, reach out to the physician to obtain the necessary documentation. Clear communication and collaboration with the physician are essential to resolve this issue.
2. Obtain the patient’s election consent: If the election consent is not received, contact the patient or their representative to obtain the required consent. Ensure that the consent is properly completed and signed.
3. Submit the documentation promptly: To avoid Remark Code MA54, it is crucial to submit all required documentation within the specified timeframe. Implement efficient processes to ensure timely submission.
4. Review documentation for accuracy: Before submitting any documentation, carefully review it for completeness and accuracy. Address any errors or omissions to prevent delays or denials.

4. How To Avoid It

1. Educate staff and providers: Ensure that all staff members and healthcare providers involved in the hospice care process are aware of the importance of timely documentation submission. Provide training on the requirements and deadlines.
2. Implement clear communication channels: Establish effective communication channels between the hospice care team, physicians, and patients to facilitate the timely exchange of necessary documentation.
3. Develop standardized documentation processes: Create standardized processes and templates for physician certification and patient election consent to streamline the documentation collection and submission process.
4. Utilize electronic systems: Implement electronic systems for documentation management to enhance efficiency and reduce the risk of delays or errors in the submission process.

5. Example Cases

1. Case 1: A claim for hospice care is denied because the physician certification was not obtained within the required timeframe, highlighting the importance of timely documentation.
2. Case 2: A claim adjustment occurs because the patient’s election consent for hospice care was not received, emphasizing the need for proper consent documentation.

Source: Remittance Advice Remark Codes