N143Remark Code (RARC)Active
N143 Remark Code: Patient Not in Hospice Program
The N143 remark code indicates that the patient was not enrolled in a hospice program during the service dates for which claims were submitted. This remark is typically seen in conjunction with a claim adjustment reason code that relates to hospice services and eligibility. It highlights a potential issue with coverage for the billed services due to the patient's status.
How It Relates to the Denial
The N143 remark code often accompanies adjustment reason codes that indicate denial of hospice-related claims. This combination signals to the biller that the services rendered may not be eligible for reimbursement because the patient was not in a hospice program at the time of service.
Common Scenarios
1A claim for palliative care services was submitted for a patient who had been receiving hospice care. The remittance shows the N143 remark code alongside a denial reason for hospice services.
→ This indicates the payer is denying the claim because the patient wasn't in hospice for the entire period of service, suggesting the services billed may not be covered.
2A provider billed for a home health visit under hospice care, but the claim was denied with the N143 remark code present.
→ The remark points out that the patient was not enrolled in the hospice program for the dates of service, indicating a coverage issue.
3A facility submitted a claim for a patient’s treatment while they were in a hospice setting, but the claim returned with the N143 remark code.
→ The payer is clarifying that the patient did not have hospice status for the full duration of care provided, affecting reimbursement.
What to Do
- Verify the patient's hospice eligibility during the service dates billed.
- Review the claim submission to ensure the correct hospice status was indicated.
- Consider resubmitting the claim if the hospice status has been confirmed for the service dates.
What to Check
- Patient's eligibility records for hospice coverage during the service dates.
- Claim documentation to confirm the services rendered align with hospice benefit guidelines.
- The original claim submission to ensure all required information was included regarding hospice enrollment.