Remark code N79 indicates a billing error where the service provided doesn't match the patient's location details.
Remark code N79 indicates that the service billed does not align with the recorded location information for the patient. This discrepancy suggests that the healthcare provider's claim may have included a service that is not considered appropriate or covered based on where the patient was reported to be at the time of service. The provider should review the patient location information and services billed to ensure accuracy and compliance with payer requirements.
Common causes of code N79 are:
1. The service was provided at a location that does not match the location on the patient's insurance policy or coverage plan.
2. The claim was submitted with an incorrect place of service (POS) code that does not align with the actual location where the healthcare service was rendered.
3. There may have been a data entry error when inputting the patient's location information into the billing system.
4. The patient may have received services at a facility not covered under their current insurance plan, such as out-of-network or non-contracted facilities.
5. The healthcare provider's billing department may have used outdated or incorrect location information for the patient.
6. The insurance payer's records may not have been updated to reflect the patient's current location or eligibility for services at the location where they were provided.
Ways to mitigate code N79 include ensuring that the patient's location information is accurately captured and clearly documented in their health record. Before submitting a claim, verify that the service code aligns with the patient's location at the time of service, as per the payer's guidelines. Regularly train billing staff on the importance of matching service codes with the appropriate location and conduct periodic audits to check for consistency and accuracy in claims submissions. Implement a robust pre-claim review process to catch discrepancies between the service provided and the patient location information, and use automated software that flags potential incompatibilities before claims are submitted to the payer.
The steps to address code N79 involve verifying the accuracy of the patient location information on the claim. First, review the patient's file and the original billing documentation to ensure that the service location was entered correctly. If an error is found, correct the patient location information and resubmit the claim.
If the patient location information is accurate, check that the service billed is appropriate for the location code used. Consult the Current Procedural Terminology (CPT) or Healthcare Common Procedure Coding System (HCPCS) codes and their associated place of service (POS) codes to confirm compatibility. If the service code is incorrect, adjust it to reflect the appropriate service for the patient's location and resubmit the claim.
In cases where both the patient location and service codes are correct, contact the payer for clarification on the specific billing guidelines for services rendered at different locations. Document the conversation and any instructions provided by the payer representative. If necessary, appeal the claim with supporting documentation that justifies the compatibility of the service with the patient location.
Additionally, ensure that your billing staff is trained on the correct use of POS codes and that they have access to the latest coding resources and payer-specific billing guidelines to prevent future occurrences of code N79.
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