248Denial Code (CARC)Active
PR 248 Denial Code - Coinsurance Fix Steps
Code 248 indicates that the coinsurance for a professional service provided in an institutional setting has been applied to a claim billed on an institutional claim form. This adjustment is specifically for Medicare bundled payments under the Patient Protection and Affordable Care Act (PPACA).
Who Pays: Group Code Liability
With code 248, the group code PR is applied, meaning the coinsurance amount is the patient's responsibility and can be billed to the patient.
Why Claims Get Code 248
- The service was provided by a professional in a hospital or other institutional setting and billed on an institutional claim.
- The claim is subject to Medicare bundled payment regulations under the PPACA.
- Coinsurance was not collected from the patient at the time of service.
- The billing system did not account for coinsurance in the institutional setting.
How to Fix & Resubmit
- Verify that the service was correctly billed on an institutional claim form.
- Check that the coinsurance amount is accurately calculated according to the Medicare bundled payment rules.
- Ensure the patient's coinsurance responsibility aligns with their Medicare plan terms.
- Contact the patient to inform them of their coinsurance responsibility and arrange for payment.
- If an error is found in the coinsurance calculation, submit a corrected claim with the appropriate adjustments.
Corrected Claim or Appeal?
For code 248, submitting a corrected claim may be necessary if the coinsurance calculation was incorrect. An appeal is not typically warranted unless the coinsurance application contradicts Medicare rules.
Preventing Future 248 Denials
- Ensure billing staff are trained on Medicare bundled payment rules under PPACA.
- Verify patient insurance details and coinsurance obligations before claim submission.
- Implement system checks to confirm correct billing form usage for institutional settings.
- Regularly audit claims to ensure coinsurance is properly applied and billed.