How To Fix Remark Code M288 (RARC) | Common Reasons, Next Steps & How To Avoid It

Remark Code N67 means that professional provider services are not paid separately and are included in the facility payment under a demonstration project. This code is used when healthcare providers need to apply to the facility for payment or resubmit their claim under specific circumstances related to the demonstration project.

1. Description

Remark Code N67 indicates that professional provider services are not paid separately and are included in the facility payment under a demonstration project. The official description states: ‘Professional provider services not paid separately. Included in facility payment under a demonstration project. Apply to that facility for payment, or resubmit your claim if: the facility notifies you the patient was excluded from this demonstration; or if you furnished these services in another location on the date of the patient’s admission or discharge from a demonstration hospital. If services were furnished in a facility not involved in the demonstration on the same date the patient was discharged from or admitted to a demonstration facility, you must report the provider ID number for the non-demonstration facility on the new claim.’

2. Common Reasons

1. Services included in facility payment: Remark Code N67 is used when professional provider services are already included in the payment made to the facility under a demonstration project. This means that separate payment for these services is not allowed.
2. Exclusion from the demonstration: If the facility notifies the healthcare provider that the patient was excluded from the demonstration project, Remark Code N67 is applied to indicate that separate payment is not applicable.
3. Services provided in another location: If the healthcare provider furnished the services in another location on the date of the patient’s admission or discharge from a demonstration hospital, separate payment is not allowed, and Remark Code N67 is used.
4. Services provided in a non-demonstration facility: If the services were furnished in a facility not involved in the demonstration on the same date the patient was discharged from or admitted to a demonstration facility, the healthcare provider must report the provider ID number for the non-demonstration facility on the new claim.

3. Next Steps

1. Apply to the facility for payment: If Remark Code N67 is received, healthcare providers need to contact the facility involved in the demonstration project to apply for payment. The facility will provide further instructions on the payment process.
2. Resubmit the claim: In certain situations, healthcare providers may need to resubmit their claim if the facility notifies them that the patient was excluded from the demonstration project or if the services were furnished in another location on the date of the patient’s admission or discharge from a demonstration hospital.

4. How To Avoid It

1. Understand the demonstration project: Healthcare providers should familiarize themselves with the details of the demonstration project to determine which services are included in the facility payment and not eligible for separate payment.
2. Coordinate with the facility: Maintaining open communication with the facility involved in the demonstration project is crucial to ensure proper payment and avoid Remark Code N67. Providers should clarify any doubts or questions regarding payment arrangements.
3. Report accurate information: When submitting claims, healthcare providers must accurately report the location of services and the provider ID number for non-demonstration facilities, if applicable, to avoid claim denials or adjustments related to Remark Code N67.

5. Example Cases

1. Case 1: A healthcare provider submits a claim for professional provider services that were already included in the facility payment under a demonstration project. The claim is denied with Remark Code N67, indicating that separate payment is not allowed.
2. Case 2: A healthcare provider furnishes services in another location on the date of the patient’s admission to a demonstration hospital. When submitting the claim, the provider forgets to report the provider ID number for the non-demonstration facility. The claim is adjusted with Remark Code N67, highlighting the need for accurate reporting.

Source: Remittance Advice Remark Codes