Remark code N364 indicates that, per the agreement, deductible and/or coinsurance amounts must be waived by the provider.
Remark code N364 indicates: Alert: According to our agreement, you must waive the deductible and/or coinsurance amounts.
Common causes of code N364 are incorrect billing of services that should have been covered under a contractual agreement which stipulates the waiver of deductible and/or coinsurance amounts for specific services or under certain conditions, misinterpretation of the agreement terms by the billing department, or failure to update billing systems to reflect current contractual obligations with the payer.
Ways to mitigate code N364 include implementing a thorough verification process for patient insurance coverage before services are rendered. This involves confirming the specifics of the patient's plan, including deductible and coinsurance requirements, and understanding any agreements between your healthcare facility and the insurance provider. Training staff to recognize and adhere to these agreements during the billing process is crucial. Additionally, utilizing advanced billing software that can flag potential discrepancies based on payer contracts can help prevent this issue. Regular audits of billing and coding practices to ensure compliance with all agreements and updating these practices as contracts change are also effective strategies.
The steps to address code N364 involve a series of actions to ensure compliance and financial accuracy. Initially, review the patient's account to confirm the application of the deductible and/or coinsurance amounts in question. If these amounts have been incorrectly applied, adjust the patient's bill to reflect the correct balance, waiving the deductible and/or coinsurance as indicated by the agreement. Next, update the billing system to document the adjustment and the reason behind it, ensuring that any future billing complies with the agreement terms. Communicate the adjustment to the patient, providing a clear explanation of the changes made to their account. Lastly, conduct an internal audit of similar cases to ensure this requirement is consistently met across all applicable patient accounts, adjusting any discrepancies found during the review. This proactive approach not only addresses code N364 but also helps in maintaining compliance and fostering trust with patients.
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