How To Fix Remark Code M308 (RARC) | Common Reasons, Next Steps & How To Avoid It

Remark Code N88 means that the payment being made is conditional. It indicates that an HHA (Home Health Agency) episode of care notice has been filed for the patient. Under consolidated billing requirements, certain therapy services and supplies, such as the one in question, must be included in the HHA’s payment. If it is determined that the patient is concurrently receiving treatment under a HHA episode of care, this payment will need to be recouped.

1. Description

Remark Code N88 is an alert code that signifies a conditional payment. It indicates that an HHA episode of care notice has been filed for the patient. Under consolidated billing requirements, specific therapy services and supplies, including the one mentioned in the claim, must be included in the payment made to the HHA. However, if it is later determined that the patient is concurrently receiving treatment under a HHA episode of care, the payment made will need to be recouped.

2. Common Reasons

1. Concurrent treatment under a HHA episode of care: The most common reason for Remark Code N88 is when the patient is receiving treatment from a Home Health Agency under an episode of care. This triggers the requirement for consolidated billing, where certain services and supplies are included in the HHA’s payment.

3. Next Steps

1. Review the patient’s treatment history: It is essential to thoroughly review the patient’s treatment history to determine if they are concurrently receiving treatment under a HHA episode of care. This can involve checking medical records, communication with the HHA, and verifying the dates of service.
2. Coordinate with the HHA: If it is confirmed that the patient is receiving treatment under a HHA episode of care, it is necessary to coordinate with the HHA to ensure proper billing and payment arrangements. This may involve submitting the claim to the HHA for inclusion in their payment.
3. Recoup the payment if necessary: If it is established that the patient is concurrently receiving treatment under a HHA episode of care, the payment made will need to be recouped. This may involve adjusting the claim or seeking reimbursement from the provider.

4. How To Avoid It

1. Thoroughly assess the patient’s treatment status: Before submitting a claim, it is crucial to assess the patient’s treatment status and determine if they are currently under a HHA episode of care. This can help avoid potential issues with consolidated billing requirements.
2. Communicate with the HHA: Maintaining open lines of communication with the HHA can help ensure proper coordination and billing. It is important to share relevant information and verify the treatment status of the patient.
3. Follow consolidated billing guidelines: Familiarize yourself with the consolidated billing guidelines to understand which services and supplies are included in the HHA’s payment. This knowledge can help ensure accurate billing and avoid potential recoupment situations.

5. Example Cases

1. Case 1: A payment is made for therapy services provided to a patient, but it is later discovered that the patient is concurrently receiving treatment under a HHA episode of care. The payment will need to be recouped from the provider.
2. Case 2: A claim is denied because the therapy services were not included in the HHA’s payment as required by consolidated billing. The provider needs to coordinate with the HHA to rectify the billing and ensure proper payment.

Source: Remittance Advice Remark Codes