How To Fix Remark Code M218 (RARC) | Common Reasons, Next Steps & How To Avoid It

Remark Code MA118 means that no Medicare payment has been issued for a claim involving services or supplies provided to a Medicare-eligible veteran through a facility of the Department of Veterans Affairs. This code is used to alert healthcare providers and coders that coinsurance and/or deductible may be applicable for this claim.

1. Description

Remark Code MA118 indicates that no Medicare payment has been issued for a claim involving services or supplies furnished to a Medicare-eligible veteran through a facility of the Department of Veterans Affairs. The official description states: ‘Alert: No Medicare payment issued for this claim for services or supplies furnished to a Medicare-eligible veteran through a facility of the Department of Veterans Affairs. Coinsurance and/or deductible are applicable.’ This remark code serves as a notification to healthcare providers and coders that additional payment responsibilities may apply to this particular claim.

2. Common Reasons

1. Incorrect billing information: One common reason for Remark Code MA118 is when the billing information provided does not accurately reflect the services or supplies furnished to a Medicare-eligible veteran through a Department of Veterans Affairs facility. This can include errors in coding, incorrect patient information, or missing documentation.
2. Lack of authorization: Another reason for this remark code is when the services or supplies provided were not properly authorized by the Department of Veterans Affairs. It is essential to ensure that all necessary authorizations and approvals are obtained before submitting a claim to Medicare.
3. Non-covered services or supplies: Remark Code MA118 may also be triggered when the services or supplies furnished are not covered by Medicare. It is important to review the Medicare coverage guidelines and ensure that the services or supplies meet the necessary criteria for reimbursement.
4. Incomplete or missing documentation: Insufficient or missing documentation can also result in Remark Code MA118. It is crucial to provide complete and accurate documentation to support the claim and demonstrate the medical necessity of the services or supplies provided.

3. Next Steps

1. Review the billing information: Carefully review the billing information to ensure accuracy and completeness. Verify that the services or supplies furnished to the Medicare-eligible veteran through a Department of Veterans Affairs facility are correctly documented and coded.
2. Obtain proper authorization: If the services or supplies were not properly authorized, work with the Department of Veterans Affairs to obtain the necessary authorizations and approvals before resubmitting the claim to Medicare.
3. Verify Medicare coverage: Confirm that the services or supplies provided are covered by Medicare. Review the Medicare coverage guidelines and ensure that the services or supplies meet the necessary criteria for reimbursement.
4. Provide complete and accurate documentation: Ensure that all required documentation is included with the claim submission. This includes medical records, test results, and any other supporting documentation that demonstrates the medical necessity of the services or supplies provided.

4. How To Avoid It

1. Ensure accurate billing: Double-check all billing information to ensure accuracy. Verify that the services or supplies furnished to the Medicare-eligible veteran through a Department of Veterans Affairs facility are correctly documented and coded.
2. Obtain proper authorization: Work closely with the Department of Veterans Affairs to obtain the necessary authorizations and approvals before submitting the claim to Medicare. This will help ensure that the services or supplies provided are eligible for reimbursement.
3. Review Medicare coverage guidelines: Familiarize yourself with the Medicare coverage guidelines to ensure that the services or supplies meet the necessary criteria for reimbursement. Stay updated on any changes or updates to the coverage policies.
4. Provide complete and accurate documentation: Thoroughly document the medical necessity of the services or supplies provided. Include all relevant medical records, test results, and other supporting documentation to support the claim.

5. Example Cases

1. Case 1: A claim for services provided to a Medicare-eligible veteran through a Department of Veterans Affairs facility is denied because the billing information does not accurately reflect the services rendered. The healthcare provider reviews the claim, corrects the billing information, and resubmits the claim with the necessary documentation, resulting in successful reimbursement.
2. Case 2: A claim for non-covered services provided to a Medicare-eligible veteran through a Department of Veterans Affairs facility is denied. The healthcare provider reviews the Medicare coverage guidelines, identifies the non-covered services, and communicates with the patient to explore alternative options for coverage or payment.

Source: Remittance Advice Remark Codes