How To Fix Remark Code M855 (RARC) | Common Reasons, Next Steps & How To Avoid It

Remark Code N655 means that the payment is based on the provider’s geographic region. This code is used to indicate that the reimbursement amount for a particular service or procedure is determined by the location where the service was rendered. Understanding this code is important for medical coders and billing professionals to ensure accurate reimbursement and claims processing.

1. Description

Remark Code N655 indicates that the payment for a specific service or procedure is based on the provider’s geographic region. The official description states: ‘Payment based on provider’s geographic region.’ This means that the amount of reimbursement for a particular service may vary depending on the location where the service was performed. It is essential to consider the regional factors that can influence the cost of healthcare services.

2. Common Reasons

1. Regional cost differences: The cost of providing healthcare services can vary significantly from one geographic region to another. Remark Code N655 is used to account for these differences and ensure fair reimbursement based on the provider’s location.
2. Insurance network agreements: Insurance companies often have different reimbursement rates based on the provider’s geographic region. This code helps to align the payment with the agreed-upon rates within the specific network.
3. Government regulations: Certain government programs or regulations may require payment adjustments based on the provider’s geographic region. Remark Code N655 ensures compliance with these regulations.

3. Next Steps

1. Verify the provider’s geographic region: It is crucial to accurately determine the provider’s location to ensure proper reimbursement. This information can be obtained from the provider’s address or other relevant documentation.
2. Understand regional payment policies: Familiarize yourself with the payment policies of different insurance companies and government programs to ensure compliance and accurate claims submission.
3. Review reimbursement rates: Stay updated on the reimbursement rates specific to each geographic region to ensure accurate billing and avoid potential payment discrepancies.

4. How To Avoid It

1. Verify insurance network participation: Ensure that the provider is part of the insurance network and has agreed-upon reimbursement rates for the specific geographic region.
2. Accurately document the service location: Properly document the address or location where the service was rendered to support accurate reimbursement based on the provider’s geographic region.
3. Stay informed about regional payment policies: Regularly review and stay updated on the payment policies of different insurance companies and government programs to ensure compliance and accurate claims submission.

5. Example Cases

1. Case 1: A provider in a high-cost metropolitan area receives higher reimbursement for a specific procedure compared to a provider in a rural area. Remark Code N655 is used to indicate the payment adjustment based on the provider’s geographic region.
2. Case 2: An insurance company has different reimbursement rates for providers in different states. Remark Code N655 is applied to ensure that the payment aligns with the agreed-upon rates for each geographic region.

Source: Remittance Advice Remark Codes