Remark code N870 is an alert indicating cost sharing was based on the billed amount, as it was lower than the qualifying payment amount, per the No Surprises Act.
Remark code N870 is an alert indicating that, as per the No Surprises Act, the cost-sharing responsibility for the patient was calculated based on the billed amount, because this amount was lower than the qualifying payment amount.
Common causes of code N870 are incorrect billing practices where the billed amount is lower than the qualifying payment amount, misunderstanding or lack of awareness of the No Surprises Act regulations, errors in calculating the qualifying payment amount, or inaccuracies in the billing system that fail to properly apply the No Surprises Act provisions.
Ways to mitigate code N870 include implementing thorough pre-service cost estimation processes. This involves accurately estimating the cost of services before they are rendered to ensure that the billed amount aligns closely with the qualifying payment amount. Additionally, healthcare providers should engage in regular training for billing staff on the No Surprises Act to ensure compliance and understanding of how to accurately determine qualifying payment amounts. Regular audits of billing practices can also help identify discrepancies early, allowing for adjustments before claims are submitted. Establishing clear communication channels with payers to discuss and resolve any discrepancies in qualifying payment amounts versus billed amounts can further prevent this code from occurring.
The steps to address code N870 involve a multi-faceted approach to ensure compliance with the No Surprises Act and to optimize the revenue cycle management process. Firstly, it's crucial to conduct a thorough review of the billing and coding process to identify any discrepancies or errors that may have led to the billed amount being lower than the qualifying payment amount. This may involve auditing recent claims to ensure that services are coded accurately and that the billed amounts are in line with the usual rates for such services.
Secondly, engage with the billing team to reinforce the importance of accurate charge capture and to provide additional training if necessary. This could help prevent future occurrences of the billed amount being lower than the qualifying payment amount.
Thirdly, consider implementing a software solution that automatically compares billed amounts with the qualifying payment amounts for services covered under the No Surprises Act. This technology can flag discrepancies before claims are submitted, allowing for corrections that align with the required standards.
Additionally, establish a communication channel with payers to discuss any discrepancies or concerns related to the qualifying payment amount. This proactive approach can help resolve issues more efficiently and foster a better understanding of payer expectations and requirements.
Finally, monitor and document all actions taken to address code N870. This documentation can serve as a reference for future occurrences and can also be used as evidence of compliance efforts in case of audits or disputes. Continuous improvement efforts should be focused on minimizing the occurrence of this code, thereby ensuring that billing practices are compliant and that revenue is maximized.
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