N912Remark Code (RARC)Active
N912 Remark Code - Beneficiary Did Not Elect Hospice
The N912 remark code indicates that the payer's records show the beneficiary did not elect hospice services. This remark supplements a Claim Adjustment Reason Code by clarifying that the lack of hospice election is the basis for the adjustment in payment or denial.
How It Relates to the Denial
N912 typically accompanies adjustment reason codes related to hospice services. The combination signals that a claim was denied or adjusted because the beneficiary did not choose hospice care, which impacts coverage and payment.
Common Scenarios
1A claim was submitted for hospice services for a patient who had not elected hospice care. The remittance advice returned a denial with an accompanying adjustment reason code.
→ The N912 remark code clarifies that the denial is specifically due to the beneficiary not electing hospice, indicating that coverage for the service is not applicable.
2A provider billed for hospice care, but the payer returned a remittance with a reduction in payment along with N912. The provider is unsure why the claim was adjusted.
→ The N912 remark code indicates the adjustment is rooted in the fact that the patient did not elect hospice services, and therefore, the payment reduction is justified.
3A facility submitted a claim for hospice support services, but the payment was denied with a reason code and the N912 remark following it.
→ The N912 remark code indicates that the claim's denial is directly related to the beneficiary's choice not to elect hospice, guiding the provider on the reason for the denial.
What to Do
- Review the beneficiary's election status for hospice care to confirm if they did not elect it.
- If the beneficiary did indeed elect hospice, consider appealing the claim with appropriate documentation to support the election.
- Ensure that future claims for hospice services are only submitted when the beneficiary has elected hospice.
What to Check
- Check the patient's hospice election documentation to verify their status.
- Review the claim details to ensure the services billed align with the patient's election status.
- Consult the payer's policy on hospice services to understand coverage implications related to election status.