N119Remark Code (RARC)Active
N119 Remark Code - Service Not Paid After Inpatient Stay
The N119 remark code indicates that the service billed is not eligible for payment if it was billed once every 28 days, and the patient has been in an inpatient or Skilled Nursing Facility (SNF) for five or more consecutive days during that timeframe. This means the payer is denying payment based on the patient's recent facility stay and the billing frequency of the service.
How It Relates to the Denial
Typically, N119 accompanies claim adjustment reason codes related to service frequency or patient status. The combination signals that the payer is applying a policy regarding the timing of service billing in relation to the patient's recent inpatient or SNF care.
Common Scenarios
1A provider bills for a home health service that is typically billed every 28 days, but the patient was in an inpatient facility for the last week of that billing period.
→ The N119 remark suggests that the service is not payable due to the patient's recent stay in an inpatient setting, indicating that the billing frequency does not meet the payer's criteria.
2A facility submits a claim for physical therapy provided to a patient who has recently spent time in a Skilled Nursing Facility for more than five days within the last 28 days.
→ The presence of the N119 remark indicates that the therapy service is being denied because the patient’s recent SNF stay affects the eligibility for payment based on the billing guidelines.
3A claim for a routine check-up is submitted for a patient who was in a hospital for several days within the last month, and the remittance shows the N119 remark code.
→ The remark code suggests that the check-up is not covered due to the patient’s recent inpatient stay, highlighting the payer’s restrictions on billing after such events.
What to Do
- Review the patient's recent facility stay and verify the dates of admission and discharge.
- Confirm that the service was not billed more frequently than allowed by the payer's policy regarding the 28-day interval.
- If the service was billed correctly, consider appealing the denial with supporting documentation of the patient's care.
What to Check
- The patient's admission and discharge dates from the inpatient or Skilled Nursing Facility.
- The billing history for the service to ensure compliance with the 28-day billing frequency.
- The claim adjustment reason code that accompanies N119 for further context on the denial.