M107Remark Code (RARC)Active
M107 Remark Code - Payment Reduced for ESRD Hematocrit
The M107 remark code indicates that the payment for a claim has been reduced because the 90-day rolling average hematocrit level for an ESRD patient exceeded 36.5%. This serves as an explanation for a previously communicated adjustment on the remittance advice.
How It Relates to the Denial
The M107 remark code typically accompanies a claim adjustment reason code related to payment reductions for ESRD patients. This combination signals that the adjustment is based on clinical metrics, specifically hematocrit levels, that influence payment calculations.
Common Scenarios
1A claim was submitted for dialysis services provided to an ESRD patient, and the remittance shows a reduction in payment.
→ The M107 remark code indicates that the reduction is due to the patient's hematocrit level exceeding the specified threshold, which is a factor in determining payment for ESRD services.
2A provider receives an 835 remittance for a series of lab tests performed on an ESRD patient, with a noted payment adjustment.
→ Seeing the M107 remark code means the payment was adjusted based on the patient's hematocrit readings, which were above the allowable limit, affecting the overall reimbursement.
3A facility bills for an ESRD patient's treatment, and the remittance advises a lower payment amount with the M107 code noted.
→ The presence of the M107 code clarifies that the payment reduction is directly linked to the patient's 90-day rolling average hematocrit exceeding the 36.5% threshold.
What to Do
- Review the claim adjustment reason code that accompanies the M107 remark for more details on the payment reduction.
- Ensure that the patient's hematocrit levels are documented and monitored as per guidelines to avoid future adjustments.
- Consider discussing the adjustment with the clinical team to understand the patient's hematocrit trends and implications for billing.
What to Check
- The patient's hematocrit level records for the past 90 days to confirm the reported values.
- The claim adjustment reason code that is paired with the M107 remark for additional context on the payment reduction.
- The payer's policy on payment adjustments related to hematocrit levels for ESRD patients to ensure compliance.