Remark code N728 indicates a workers' comp insurer is responsible for ongoing medical services for the specified diagnosis.
Remark code N728 indicates that a workers' compensation insurer has reported having ongoing responsibility for medical services (ORM) for this diagnosis.
Common causes of code N728 are incorrect billing of services that should be covered under a workers' compensation plan, failure to properly coordinate benefits between primary health insurance and workers' compensation insurance, or inaccuracies in the patient's insurance information leading to misassignment of financial responsibility for the medical services related to the diagnosis. Additionally, this code may arise from discrepancies in the documentation or reporting of the diagnosis and its association with a work-related injury or condition that should be covered under workers' compensation.
Ways to mitigate code N728 include implementing a robust verification process to confirm the responsibility of insurance coverage before submitting claims. This involves directly communicating with the workers' compensation insurer to clarify and document their ongoing responsibility for medical services related to the specific diagnosis. Additionally, maintaining accurate and up-to-date patient records, including detailed documentation of the diagnosis and the related workers' compensation claim information, can help in preventing this code. It's also beneficial to establish a protocol for regularly reviewing and updating insurance information to catch any changes in responsibility, especially for long-term or chronic conditions that may fall under workers' compensation. Training staff to recognize and properly handle claims that involve workers' compensation can further reduce the likelihood of encountering code N728.
The steps to address code N728 involve a multi-faceted approach to ensure that billing and claims management are handled correctly, given the involvement of a workers' compensation insurer with ongoing responsibility for medical services (ORM). Here's how to proceed:
1. Verification and Documentation: First, verify the claim and the diagnosis with the workers' compensation insurer to ensure that the information matches their records. Obtain and document any relevant case numbers, claim numbers, or authorization details provided by the insurer. This step is crucial for accurate claim processing and to avoid future discrepancies.
2. Coordination of Benefits (COB): Determine if there are other insurance payers involved and establish the order of responsibility. The workers' compensation insurer may be the primary payer for the diagnosis in question, but it's essential to identify any secondary payers and coordinate benefits accordingly. This may involve submitting claims to the secondary payer with the explanation of benefits (EOB) from the workers' compensation insurer.
3. Billing Adjustments: Adjust the billing practices for the patient in question to route the claims related to the specified diagnosis directly to the workers' compensation insurer. This may involve setting up special billing codes or flags in your practice management system to ensure that claims are sent to the correct payer without delay.
4. Communication with Patients: Communicate clearly with the patient about the billing process for their diagnosis. Ensure they understand that the workers' compensation insurer is handling their medical services for the specific diagnosis and inform them about any potential out-of-pocket costs or billing procedures they may encounter.
5. Follow-up and Reconciliation: Regularly follow up on the claim with the workers' compensation insurer to monitor its status. If there are any denials or discrepancies, address them promptly by providing additional information or clarification as needed. Keep detailed records of all communications and transactions related to the claim for future reference and reconciliation.
6. Compliance and Reporting: Ensure compliance with all relevant workers' compensation laws and regulations in your jurisdiction. This may involve specific reporting requirements or documentation standards that must be followed when dealing with workers' compensation claims.
7. Education and Training: Educate your billing and coding staff about handling claims with code N728. Regular training sessions can help keep your team updated on the best practices for managing such claims and avoiding common pitfalls.
By following these steps, healthcare providers can effectively address code N728, ensuring that claims are processed efficiently and in compliance with workers' compensation requirements.
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