Remark code N199 indicates a payer has approved extra payment or recoupment following their review or audit.
Remark code N199 indicates that an additional payment or recoupment has been approved following a review or audit initiated by the payer. This could mean that upon examining the claim, the payer has determined that a different payment amount is warranted and has adjusted the payment accordingly.
Common causes of code N199 are:
1. Post-payment audits conducted by the payer that have identified overpayments or underpayments to the provider.
2. Retroactive rate adjustments after the payer has reviewed the original claims.
3. Corrections to claims after the payer has found discrepancies during their internal review process.
4. Adjustments following a provider's appeal that has resulted in a decision to reimburse additional funds.
5. Payer-initiated reviews that have uncovered billing errors, leading to additional payments or the need for recoupment.
6. Implementation of new billing regulations or changes in coverage that necessitate a review of previously processed claims.
7. Periodic reconciliation processes by the payer that have highlighted variances in the payment history for certain services or procedures.
Ways to mitigate code N199 include implementing a robust internal auditing system to regularly review claims before submission, ensuring they meet all payer requirements and guidelines. Training staff on proper documentation practices and keeping abreast of the latest coding updates and regulations can also help prevent discrepancies that could trigger a payer-initiated review or audit. Establishing a system for double-checking high-risk claims and those with a history of additional payment or recoupment can further reduce the likelihood of encountering code N199. Regularly communicating with payers to understand their audit triggers and criteria can also aid in refining billing processes to avoid this remark code.
The steps to address code N199 involve a thorough review of the payment or recoupment notice received from the payer. First, verify the accuracy of the audit findings by comparing them with your patient account records, including service dates, procedure codes, and payment histories. If the additional payment is correct, ensure that it is posted accurately to the patient's account. In the case of a recoupment, determine the reason for the overpayment and reconcile the account accordingly. If discrepancies are found or if the recoupment seems unjustified, prepare and submit a detailed appeal to the payer, including supporting documentation that justifies the original billing. Keep track of the appeal process and maintain communication with the payer until the issue is resolved. Ensure that all adjustments are documented and that the financial records reflect the updated balance.
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